Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis


Autoři: Zhaowei Zhu aff001;  Jia Zhao aff002;  Yinghui Li aff003;  Chen Pang aff004;  Zhanwei Zhu aff005;  Xuepei Zhang aff001
Působiště autorů: Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China aff001;  Center for Geriatrics, Yidu Central Hospital of Weifang, Qingzhou, Shandong, PR China aff002;  Department of Urology, People’s Hospital of Gongyi City, Zhengzhou, Henan, PR China aff003;  Department of Urology, Nanshi Hospital of Nanyang, Nanyang, Henan, PR China aff004;  Department of Urology, People’s Hospital of Huaxian, Huaxian, Henan, PR China aff005
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222223

Souhrn

Background

Hydronephrosis is a common finding in patients with bladder cancer. The aim of the study was to appraise the prognostic value of preoperative hydronephrosis in bladder cancer patients undergoing radical cystectomy.

Methods

We conducted a literature search using PubMed and Embase databases in Aug 2018. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effects models. The primary endpoint was overall survival (OS). Secondary endpoints were cancer-specific survival (CSS) and recurrence-free survival (RFS).

Results

Overall, 13 studies published between 2008 and 2018 including 4,820 patients were selected for the meta-analysis. The age of bladder cancer patients ranged from 27 to 90.4 years, and the overall proportion of males was 72.5%. Preoperative hydronephrosis was reported in 27.4% of patients. The pooled HR was statistically significant for OS (HR, 1.36; 95% CI [1.20–1.55]) and CSS (HR, 1.64; 95% CI [1.33–2.02]), with no heterogeneity among the enrolled studies. Patients with bilateral hydronephrosis showed a poorer CSS compared to those with no hydronephrosis (HR 5.43, 95% CI [3.14–9.40]). However, there was no difference in CSS between no hydronephrosis and unilateral hydronephrosis groups (HR 1.35, 95% CI [0.84–2.14]). Despite a tendency towards poorer RFS (HR, 1.27; 95% CI [0.96–1.96]), the results demonstrated no significant association between presence of preoperative hydronephrosis and RFS after radical cystectomy.

Conclusion

This meta-analysis indicates that preoperative hydronephrosis is significantly associated with poorer OS and CSS after radical cystectomy for patients with bladder cancer. Preoperative hydronephrosis has a stronger effect on CSS in patients with bilateral hydronephrosis. The presence of preoperative hydronephrosis not only predicts prognosis, but may also help to identify patients who benefit the most from neoadjuvant chemotherapy.

Klíčová slova:

Medicine and health sciences – Oncology – Cancers and neoplasms – Genitourinary tract tumors – Bladder cancer – Cancer treatment – Urology – Surgical and invasive medical procedures – Surgical excision – Cystectomy – Urinary system procedures – Diagnostic medicine – Prognosis – Research and analysis methods – Mathematical and statistical techniques – Statistical methods – Metaanalysis – Database and informatics methods – Database searching – Physical sciences – Mathematics – Statistics – Science policy – Research integrity – Publication ethics – People and places – Geographical locations – North America – United States


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PLOS One


2019 Číslo 9
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