title: A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma.
abstract: BACKGROUND
  There is an ongoing debate about the factors that influence intravesical recurrence (IVR) after radical nephrouretectomy (RNU) to treat upper tract urothelial carcinoma (UTUC).
  
  
  OBJECTIVE
  To assess significant predictors of IVR after RNU from a systematic review of the literature and meta-analysis.
  
  
  METHODS
  A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all reports that included detailed results of multivariate analyses on the predictors of IVR. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, we selected 18 retrospective studies that each included more than 100 patients treated exclusively with RNU between 2007 and 2014. Cumulative analyses of available hazard ratios (HRs) and their corresponding 95% confidence intervals were conducted using R software to assess the potential predictors of IVR.
  
  
  RESULTS
  Among the 8275 patients included, 2402 (29%) were diagnosed with IVR within a median time of 22.2 mo (range 6.7-56.5). Patient-specific predictors were as follows: male gender (HR 1.37; p<0.001), previous bladder cancer (HR 1.96; p<0.001), and preoperative chronic kidney disease (HR 1.87; p=0.002). Tumor-specific predictors were as follows: positive preoperative urinary cytology (HR 1.56; p<0.001), ureteral location (HR 1.27; p<0.001), multifocality (HR 1.61; p=0.002), invasive pT stage (HR 1.38; p<0.001), and necrosis (HR 2.17; p=0.02). Treatment-specific predictors were as follows: a laparoscopic approach (HR 1.62; p=0.003), extravesical bladder cuff removal (HR 1.22; p=0.02), and positive surgical margins (HR 1.90; p=0.004).
  
  
  CONCLUSIONS
  A meta-analysis of available data identified significant predictors of IVR that should be systematically assessed to propose a risk-adapted approach to adjuvant intravesical instillation of chemotherapy and cystoscopic surveillance after RNU.
  
  
  RESULTS
  In this report, we looked at the factors linked to intravesical recurrence after radical nephroureterectomy to treat upper urinary tract urothelial carcinoma. We identified patient-, tumor- and treatment-specific characteristics that should be systematically assessed to guide postoperative decision-making.
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Academic Department of Public Health and Biostatistics, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.affiliation: Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Paris, France.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Léon
authors.affiliation: Academic Library of Medicine, Paris Descartes University, Paris, France.
authors.forename: Guillemette
authors.initials: G
authors.lastname: Utard
authors.affiliation: Academic Department of Radiology, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Renard-Penna
authors.affiliation: Academic Department of Pathology, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mozer
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.affiliation: Academic Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Paris, France. Electronic address: morgan.roupret@psl.aphp.fr.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000517:prevention & control; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D014551:Urinary Tract / Q000473:pathology / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery
chemical_list: D015415:Biomarkers
keywords: Bladder neoplasm; Prognostic; Recurrence; Renal pelvis; Survival; Ureter; Urinary tract; Urothelial carcinoma