A systematic review and meta-analysis of oncological and renal function outcomes obtained after segmental ureterectomy versus radical nephroureterectomy for upper tract urothelial carcinoma.
OBJECTIVE
To perform a systematic review and meta-analysis of the comparative studies reporting oncological and renal function outcomes of segmental ureterectomy (SU) versus radical nephroureterectomy (RNU) for upper tract urothelial carcinomas (UTUC).


METHODS
A literature search on Pubmed, Embase, and the Cochrane library was conducted according to the PRISMA guidelines, and a meta-analysis was performed to assess cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS), intravesical recurrence free survival (IVRFS) and surgery-related variations in estimated glomerular filtration rate (eGFR).


RESULTS
A total of 11 retrospective studies with 3963 patients who underwent either SU (n = 983; 24.8%) or RNU (n = 2980; 75.2%) were included. Although patients treated with SU were more likely to be diagnosed with favorable pathological features, the meta-analysis of unadjusted data revealed no significant difference between both groups in terms of CSS (HR 0.90, p = 0.33) and OS (HR 0.98, p = 0.93). Accordingly, the meta-analysis of adjusted data confirmed equivalent CSS (HR = 0.90, p = 0.47) between SU and RNU. Similarly, no significant difference was found in terms of RFS (HR 1.06, p = 0.72) and IVRFS (HR 1.35, p = 0.39). However, a significant decreased risk of impaired renal function was observed after SU when compared to RNU (mean eGFR difference = 9.32 ml/1.73 m2, p = 0.007).


CONCLUSIONS
Although adverse patient and tumor characteristics were not equally balanced between treatment arms, our systematic review and meta-analysis supports similar oncological outcomes between SU and RNU, with better preservation of renal function after SU. As such, SU should be preferably used as the first-line treatment for low-risk ureter tumors, while considered for selected cases of high-risk disease.
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Fang
Academic Department of Urology, Pitié Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, Paris F-75013, France; UPMC University Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris F-75005, France.
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Seisen
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Yang
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Liu
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Rd, Yuexiu District, Guangzhou 510120, China.
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Fan
Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
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Singla
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Xiong
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Zhang
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China. Electronic address: pineneedle@sina.com.
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Li
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku St, Xicheng District, Beijing 100034, China.
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Zhou
D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
Kidney-sparing surgery; Meta-analysis; Radical nephroureterectomy; Segmental ureterectomy; Upper tract urothelial carcinomas