title: The effect of intravesical chemotherapy in the prevention of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a meta-analysis.
abstract: BACKGROUND
  The standard management of upper urinary tract urothelial carcinoma (UUT-UC) is nephroureterectomy with bladder cuff excision, but after surgery, approximately 22-47% of patients with UUT-UC develop subsequent bladder tumour recurrence, potentially because of the implantation of cancer cells from the primary tumour.
  
  
  OBJECTIVE
  To conduct a meta-analysis to evaluate the effect of prophylactic intravesical chemotherapy in the prevention of bladder recurrence after nephroureterectomy for UUT-UC.
  
  
  METHODS
  An electronic database search of Medline, Embase, the Cochrane Library, CancerLit and ClinicalTrials.gov was performed to identify appropriate studies prior to March 2013.All studies comparing nephroureterectomy alone with prophylactic intravesical chemotherapy after nephroureterectomy were included. The main outcome measure for this meta-analysis was the rate of bladder recurrence after nephroureterectomy. The search was not limited by language. The review process followed the guidelines of the Cochrane Collaboration. The analysis was conducted using the Review Manager Version RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration).
  
  
  RESULTS
  A total of 592 patients were included in this study, of whom 257 underwent intravesical instillation after nephroureterectomy and 335 underwent nephroureterectomy alone. Our meta-analysis demonstrated that the rate of recurrence after 12 months was significantly lower in the intravesical instillation after nephroureterectomy group than in the nephroureterectomy-alone group [odds ratio (OR): 0.48; 95% confidence interval (CI): 0.28-0.81; P = 0.006]. A significant decrease in bladder recurrence after at least 24  months was also observed in the intravesical instillation after nephroureterectomy group (OR: 0.40; 95% CI: 0.24-0.67; P = 0.0004). A subgroup analysis demonstrated that the pattern of differences was similar to those from the total group analysis.
  
  
  CONCLUSIONS
  Prophylactic intravesical chemotherapy was effective for the prevention of bladder recurrence after nephroureterectomy. Therefore, we suggest that prophylactic intravesical chemotherapy should be performed in patients with UUT-UC after nephroureterectomy, but the optimal chemotherapy regimen and the initial time of instillation should be explored in future studies.
authors.forename: Haichao
authors.initials: H
authors.lastname: Yuan
authors.forename: Xiangming
authors.initials: X
authors.lastname: Mao
authors.forename: Yunjin
authors.initials: Y
authors.lastname: Bai
authors.forename: Hengping
authors.initials: H
authors.lastname: Li
authors.forename: Liangren
authors.initials: L
authors.lastname: Liu
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Pu
authors.forename: Jinhong
authors.initials: J
authors.lastname: Li
authors.forename: Yin
authors.initials: Y
authors.lastname: Tang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
authors.forename: Ping
authors.initials: P
authors.lastname: Han
mesh_terms: D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D009392:Nephrectomy / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents
keywords: Bladder recurrence,; Intravesical chemotherapy,; Nephroureterectomy,; Upper tract urothelial carcinoma