Prognostic Value of Variant Histology in Upper Tract Urothelial Carcinoma Treated with Nephroureterectomy: A Systematic Review and Meta-Analysis
Language English Country United States Media print-electronic
Document type Journal Article, Meta-Analysis, Systematic Review
- Keywords
- carcinoma, histology, meta-analysis, transitional cell, urologic neoplasms, urothelium,
- MeSH
- Kaplan-Meier Estimate MeSH
- Carcinoma, Transitional Cell mortality pathology surgery MeSH
- Clinical Decision-Making methods MeSH
- Kidney pathology surgery MeSH
- Humans MeSH
- Neoplasm Recurrence, Local diagnosis prevention & control MeSH
- Kidney Neoplasms mortality pathology surgery MeSH
- Ureteral Neoplasms mortality pathology surgery MeSH
- Nephroureterectomy MeSH
- Predictive Value of Tests MeSH
- Disease-Free Survival MeSH
- Prognosis MeSH
- Feasibility Studies MeSH
- Ureter pathology surgery MeSH
- Urothelium pathology surgery MeSH
- Patient Selection MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
PURPOSE: We sought to assess the prognostic value of variant histology in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. MATERIALS AND METHODS: We searched PubMed®, Web of Science™, Cochrane Library and Scopus® databases in May 2019 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies were deemed eligible if they compared overall, cancer specific and recurrence-free survival in patients with upper tract urothelial carcinoma with or without variant histology. Formal meta-analyses were performed for these outcomes. RESULTS: We identified 32 studies with 16,052 patients, including 26 studies with 12,865 patients that were eligible for the meta-analysis. Variant histology was associated with poor outcomes in terms of cancer specific (pooled HR 2.00, 95% CI 1.57 to 2.56), overall (pooled HR 1.76, 95% CI 1.51 to 2.04) and recurrence-free survival (pooled HR 1.64, 95% CI 1.42 to 1.89). Subgroup analyses revealed that micropapillary (pooled HR 3.02, 95% CI 1.71 to 5.34), and squamous and/or glandular variant histologies (pooled HR 1.48, 95% CI 1.14 to 1.92) were also associated with poor cancer specific survival. CONCLUSIONS: Variant histology in patients with upper tract urothelial carcinoma is associated with an increased risk of cancer specific and overall mortality and disease recurrence. Furthermore, variant histology was independently associated with cancer specific survival in the micropapillary, and squamous and/or glandular variant histology subgroups. It may be useful to incorporate variant histology into prognostic tools that help guide patients and physicians in selecting appropriate treatment strategies for upper tract urothelial carcinoma.
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic Russia
Department of Urology Jikei University School of Medicine Tokyo Japan
Department of Urology Medical University of Hamburg Hamburg Germany
Department of Urology Medical University of Vienna Vienna Austria
Department of Urology Shariati Hospital Tehran University of Medical Sciences Tehran Iran
Department of Urology University of Texas Southwestern Dallas Texas
Department of Urology Weill Cornell Medical College New York New York
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
References provided by Crossref.org
