Impact Of Diagnostic Ureteroscopy On Long-term Survival In Patients With Upper Tract Transitional Cell Carcinoma

Objective: We determine whether diagnostic retrograde ureteroscopy for evaluation of upper tract transitional cell carcinoma adversely affects survival outcomes in terms of recurrence-free survival,tumor-free and overall survival.Methods: Prospective or retrospective trials published in English or Chinese were retrieved.Computer retrieval was carried out in Pub Med,EMBase,Cochrane library,Wan Fang Data,and China National Knowledge Infrastructure(CNKI)from establishment until February 1,2017 for prospective or retrospective studies on the effect of URS on the prognosis of UTUC.All the collected researches were analyzed by 2 reviewers independently according to ourinclusion and exclusion criteria.The quality of the literature was assessed,and the extracted data was systematically analyzed by using Stata 12.Results:Sixteen retrospective studies were eligible,including 7185 patients,because of its high heterogeneity were included in the article for recurrence-free survival(I2 =52.1%,P=0.10),we were Layering of the result of the tumor recurrence,thinking the articles included of tumor recurrence areas lacking of accurate positioning.Due to the related literature is less,we can't divide them into bladder tumor recurrence and bladder recurrence outside the group.We just divided them into subgroups of bladder tumor recurrence(I2=39.2%,P=0.097)and tumor recurrence subgroups(including the peritoneal recurrence,the contralateral upper tract recurrence and recurrence of bladder),(I2=16.4%,P=0.310).Results showed that URS increase the risk of disease recurrence-free survival(HR=1.39,95% CI: 1.17,1.66),especially for bladder tumor recurrence(HR=1.60,95% CI:1.33,1.94).The pooled HR of recurrencefree survivalwas(RFS)was not significant in the univariate analysis HR=1.11,95% CI: 0.89,1.38),but not in the intravesical recurrence-free survival(IRFS)(HR=1.33,95% CI: 1.07,1.67),The pooled HR of cancer specific survival(CSS)was significant in the univariate analysis(HR=0.69,95% CI: 0.54,0.87),but not in the multivariate analysis(HR=0.78,95% CI: 0.60,1.62).The pooled HR of overall survival(OS)was not significant in the univariate(HR=1.01,95% CI: 0.63,1.62).Conclusions: Preoperative URS increase the risk of tumor recurrence,especially in the bladder tumor recurrence.But the performance of URS prior to radical nephroureterectomy for UTUC has no adverse effect on cancer specific survival(CSS)and overall survival(OS).