Perioperative treatments for resected upper tract urothelial carcinoma: a network meta-analysis.
BACKGROUND
Perioperative treatments have been used to improve prognosis in patients with upper tract urothelial carcinoma (UTUC). However, optimal management remains unestablished.


METHODS
We searched the Embase, Web of Science and Cochrane databases for studies published before June 20, 2015. All included studies were categorised into three groups on the basis of the outcome reported (overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS)). Relative hazard ratios (HRs) for death were calculated using random-effects Bayesian network meta-analysis methods. We also ranked the three different treatments in terms of three outcomes.


RESULTS
A total of 31 trials with 8100 patients were included. Compared with the control, adjuvant chemotherapy (AC) could improve OS, DSS and RFS by 32% (HR 0.68, 95% CI 0.51-0.89), 29% (HR 0.71, 95% CI 0.54-0.89) and 51% (HR 0.49, 95% CI 0.23-0.85), respectively. We noted a marked prolongation of RFS in both intravesical chemotherapy (HR 0.32, 95% CI 0.09-0.69) as well as concurrent radiotherapy and intravesical chemotherapy (HR 0.32, 95% CI 0.03-0.97) than in the control. Neoadjuvant chemotherapy (NAC) showed a significant improvement in DSS relative to the control (HR 0.25, 95% CI 0.06-0.61) and a distinct advantage over AC (HR 0.36, 95% CI 0.08-0.90) or AR (HR 6.89, 95% CI 1.25-18.66).


CONCLUSIONS
Our results showed that AC; intravesical chemotherapy; and concurrent radiotherapy and intravesical chemotherapy could improve the prognosis of UTUC patients. NAC was found to be more favourable for UTUC than AC in terms of DSS.
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xiao
X
Yang
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Peng
P
Li
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xiaheng
X
Deng
Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Hongquan
H
Dong
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Yidong
Y
Cheng
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xiaolei
X
Zhang
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Chengdi
C
Yang
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jingyuan
J
Tang
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Wenbo
W
Yuan
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xiaoting
X
Xu
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jun
J
Tao
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Pengchao
P
Li
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Haiwei
H
Yang
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Qiang
Q
Lu
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Min
M
Gu
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Zengjun
Z
Wang
D001499:Bayes Theorem; D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D014523:Urethral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
network meta-analysis; perioperative treatment; upper tract urothelial carcinoma
J Urol. 2015 Apr;193(4):1122-8
25444957
Yonsei Med J. 2015 Mar;56(2):375-81
25683984
Chang Gung Med J. 2012 May-Jun;35(3):247-54
22735056
Trials. 2007 Jun 07;8:16
17555582
Int J Urol. 2008 Sep;15(9):800-3
18651862
J Urol. 2004 Oct;172(4 Pt 1):1271-5
15371822
Cancer. 2011 Dec 15;117(24):5500-8
21638278
Jpn J Clin Oncol. 2013 Nov;43(11):1139-44
24006504
Eur Urol. 2014 Apr;65(4):778-92
24373477
Urol Int. 2006;77(1):22-6
16825811
Eur Urol. 2014 Jul;66(1):42-54
24018020
Cancer. 1994 Jul 1;74(1):123-33
8004569
Curr Urol Rep. 2013 Apr;14(2):102-8
23344683
J Urol. 2015 Aug;194(2):323-9
25796114
Cancer Chemother Pharmacol. 1987;20 Suppl:S29-33
3664941
J Cancer. 2013 Oct 05;4(8):686-90
24155781
Eur Urol. 2014 Sep;66(3):529-41
24680361
J Urol. 2010 Jan;183(1):56-61
19913833
J Urol. 2009 Sep;182(3):900-6
19616245
Cancer. 2010 Jul 1;116(13):3127-34
20564621
Urol Oncol. 2014 Jan;32(1):47.e9-14
24140248
World J Urol. 2012 Oct;30(5):701-6
21984472
Radiother Oncol. 2014 Jul;112(1):140-4
24833561
BJU Int. 2014 Jun;113(6):911-7
24053651
Hematol Oncol Clin North Am. 2015 Apr;29(2):271-88, ix
25836934
N Engl J Med. 1999 Dec 30;341(27):2061-7
10615079
Urol Oncol. 2014 Jan;32(1):31.e17-24
23428535
Int J Radiat Oncol Biol Phys. 1992;24(4):743-5
1429099
Int J Urol. 2001 May;8(5):212-6
11328420
CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
22237781
Int J Clin Exp Med. 2014 Dec 15;7(12):4734-46
25663970
Eur J Cancer. 1999 May;35(5):738-43
10505034
J Urol. 2010 Nov;184(5):1895-900
20846680
Eur Urol. 2012 Jun;61(6):1229-38
22189383
Cancer. 2014 Jun 15;120(12):1794-9
24633966
BMC Cancer. 2011 Jul 14;11:297
21756352
Eur Urol. 2011 Oct;60(4):703-10
21684068
Urology. 2006 Jul;68(1):53-7
16806415
Anticancer Res. 2014 Jan;34(1):333-8
24403484
Urol Int. 2013;91(3):291-6
23948770
Eur Urol. 2015 Nov;68(5):868-79
26188393
Int J Urol. 2004 Jul;11(7):456-60
15242352
J Clin Oncol. 2013 Apr 10;31(11):1422-7
23460707
Jpn J Clin Oncol. 2012 Dec;42(12):1192-6
23077244
J Urol. 1998 Sep;160(3 Pt 1):703-6
9720526
Korean J Urol. 2015 Jan;56(1):41-7
25598935
Bull Cancer. 1996 Nov;83(11):940-4
9033604
Surg Oncol. 2011 Mar;20(1):43-55
19854042
Cancer. 2009 Mar 15;115(6):1224-33
19156917
Lancet Oncol. 2013 Oct;14(11):1095-103
24035532
Urology. 1995 Dec;46(6):796-800
7502418