Perioperative Chemotherapy for Urothelial Carcinoma of the Upper Urinary Tract: A Systematic Review and Meta-Anaysis

Publication date: Available online 22 May 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Richard W. Gregg, Francisco E. Vera-Badillo, Christopher M. Booth, Aamer Mahmud, Michael Brundage, Michael J. Leveridge, Timothy P. Hanna
IntroductionUpper tract urothelial carcinomas are rare malignancies with differences in anatomy and biology requiring therapeutic strategies that differ from bladder cancer. The role of perioperative systemic therapy in this disease remains uncertain with limited data to support its use. A systematic review of the literature and meta-analysis was therefore undertaken to provide more information and guide clinical practiceMethodsA Literature search was performed using Embase and Medline databases with additional searches performed manually using terms associated with upper tract urothelial malignancies. Data was extracted from studies of patients that underwent nephrouretectomy for the management of upper tract urothelial carcinoma and received either neoadjuvant or adjuvant systemic therapy. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were summated and analyzed using Cochrane Revman software Version 5.3.ResultsThere were 13 comparative studies and no randomized studies identified for data extraction; 11 adjuvant and 2 neoadjuvant with 1260 patients receiving perioperative systemic therapy and 3567 controls that did not. Perioperative chemotherapy was associated with improved OS (HR 0.75, 95%CI 0.57-0.99), DFS (HR 0.54, 95%CI 0.32-0.92), and CSS (HR 0.6, 95%CI 0.42-1.15).ConclusionsThe available data suggests that perioperative systemic therapy is associated with improved survival in patients with upper tract urothelial cancer.



https://ift.tt/2x3urPI