未经批准:COVID-19大流行导致医院资源和医护人员相互竞争。新诊断的浸润性膀胱尿路上皮癌(UCB)上尿路(UTUC)患者可能会分别延迟根治性膀胱切除术(RC)或根治性肾输尿管切除术(RNU)。我们评估了延迟确定性手术对侵入性UCB和UTUC生存结果的影响。
UNASSIGNED:我们搜索了截至2020年6月在Medline和Embase进行的所有关于延迟泌尿系癌症手术的研究。进行了系统评价和荟萃分析。
未经评估:我们共确定了30项研究,共32,591名患者。在13项研究中(n=12,201),从膀胱癌/TURBT诊断延迟至RC的总生存期较差(HR1.25,95%CI:1.09~1.45,p=0.002).对于在RC之前接受新辅助化疗的患者,在5项研究中(n=4,316例患者),未发现新辅助化疗和根治性膀胱切除术之间的延迟与总生存期显著相关(合并HR1.37,95%CI:0.96~1.94,p=0.08).对于UTUC,6项研究(n=4,629)发现,UTUC到RNU诊断之间的延迟与较差的总体生存率(合并HR1.55,95%CI:1.19-2.02,p=0.001)和癌症特异性生存率(合并HR为2.56,95%CI:1.50-4.37,p=0.001)相关。局限性包括研究之间的异质性,特别是在诊断到手术之间的延迟截止期的定义中。
UNASSIGNED:从诊断UCB或UTUC到明确RC或RNU的延迟与较差的生存结局相关。对于接受新辅助化疗的患者情况并非如此。
UNASSIGNED: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC.
UNASSIGNED: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed.
UNASSIGNED: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09-1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96-1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19-2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50-4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery.
UNASSIGNED: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.