目的:上尿路尿路上皮癌(UTUC)是一种罕见的恶性肿瘤,仅占5%的尿路上皮癌。治疗的主要方法是根治性肾输尿管切除术(RNU)和膀胱袖套切除术。新辅助或辅助化疗通常用于局部晚期疾病。辅助放疗(RT)的作用,然而,仍然有争议。为了进一步探索佐剂RT的潜在作用,我们对1990年至今的文献进行了系统回顾和荟萃分析.
方法:我们从数据库搜索中识别出810篇候选文章,其中67项研究进行了全文回顾,最终纳入20项符合条件的研究。在纳入的研究中,没有随机对照试验和单一的前瞻性试验,其余为回顾性系列。我们通过计算局部复发(LRR)的主要结局和总生存期(OS)的次要结局的合并比值比(OR),对结果进行了定量综合。癌症特异性生存率(CSS)和远处复发(DR)。
结果:辅助RT,主要用于RNU后的局部晚期或边缘阳性疾病,局部复发风险显着降低OR0.43(95%CI:0.23-0.70),即使在考虑辅助全身治疗的亚组分析后,效果仍然显著.佐剂RT对3年OS的影响,5年CSS和DR无显著意义。然而,辅助RT组的5年OS是不利的,但是研究的异质性很高,对小型研究效果和亚组的分析表明,在报告结局时存在偏倚.
结论:局部晚期UTUC的辅助RT可改善确定性手术后的局部控制,但似乎没有改善操作系统。更高质量的研究,理想的随机对照试验,需要进一步量化其在这种情况下的好处,并探索多模式治疗,包括与RT同时或依次给予的全身性药物,除了RT的局部区域控制优势之外,它还可以提供OS优势。
Upper tract urothelial carcinoma (UTUC) is a rare form of malignancy comprising only 5% of urothelial cancers. The mainstay of treatment is radical nephroureterectomy (RNU) with bladder cuff excision. Neoadjuvant or adjuvant chemotherapy is often used in locally advanced disease. The role of adjuvant radiotherapy (RT), however, remains controversial. To further explore the potential role of adjuvant RT, we performed a systematic
review and meta-analysis of the literature from 1990 to present.
We identified 810 candidate articles from database searches, of which 67 studies underwent full-text
review, with final inclusion of 20 eligible studies. Among the included studies, there were no randomized controlled trials and a single prospective trial, with the remainder being retrospective series. We performed quantitative synthesis of the results by calculating the pooled odds ratios (OR) for the primary outcome of locoregional recurrence (LRR) and secondary outcomes of overall survival (OS), cancer-specific survival (CSS) and distant recurrence (DR).
Adjuvant RT, which was mostly prescribed for locally advanced or margin-positive disease following RNU, significantly reduced locoregional recurrence risk OR 0.43 (95% CI: 0.23-0.70), and the effect remained significant even following subgroup analysis to account for adjuvant systemic therapy. The effect of adjuvant RT on 3-year OS, 5-year CSS and DR was non-significant. However, 5-year OS was unfavourable in the adjuvant RT arm, but study heterogeneity was high, and analysis of small-study effects and subgroups suggested bias in reporting of outcomes.
Adjuvant RT in the setting of locally advanced UTUC improves locoregional control following definitive surgery, but does not appear to improve OS. Higher-quality studies, ideally randomized controlled trials, are needed to further quantify its benefit in this setting, and to explore multi-modal treatments that include systemic agents given concomitantly or sequentially with RT, which may offer an OS benefit in addition to the locoregional control benefit of RT.