Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Runzhuo Ma; Zenan Liu; Yinchu Cheng; Pengxiang Zhou; Yuting Pan; Hai Bi; Liyuan Tao; Bin Yang; Haizhui Xia; Xuehua Zhu; Jide He; Wei He; Guoliang Wang; Yi Huang; Lulin Ma; Jian Lu

doi:10.1016/j.euros.2022.06.001

Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Eur Urol Open Sci. 2022 Jun 28:42:19-29. doi: 10.1016/j.euros.2022.06.001. eCollection 2022 Aug.

Authors

Runzhuo Ma^{1

2}, Zenan Liu¹, Yinchu Cheng³, Pengxiang Zhou³, Yuting Pan⁴, Hai Bi¹, Liyuan Tao⁵, Bin Yang¹, Haizhui Xia¹, Xuehua Zhu¹, Jide He¹, Wei He¹, Guoliang Wang¹, Yi Huang¹, Lulin Ma¹, Jian Lu¹

Affiliations

¹ Department of Urology, Peking University Third Hospital, Beijing, China.
² Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
³ Department of Pharmacy, Peking University Third Hospital, Beijing, China.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁵ Department of Biostatistics, Peking University Third Hospital, Beijing, China.

Abstract

Context: The role of tumor size in predicting prognosis in upper tract urothelial carcinoma (UTUC) patients remains poorly defined.

Objective: To assess the prognostic value of tumor size in patients with UTUC through a systematic review and meta-analysis.

Evidence acquisition: A comprehensive literature search of the PubMed and Embase databases were performed to identify all relevant articles published up to December 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Available hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were analyzed to evaluate the association between tumor size and survival outcomes.

Evidence synthesis: A total of 35 articles representing 32 292 patients met the eligibility criteria and were finally included for the meta-analysis. Tumor size was significantly associated with poor outcomes in terms of overall survival (HR = 1.42, 95% CI = 1.28-1.58), cancer-specific survival (HR = 1.66, 95% CI = 1.47-1.88), recurrence-free survival (HR = 1.25, 95% CI = 1.13-1.38), and intravesical recurrence (HR = 1.12, 95% CI = 1.04-1.20). There was between-study heterogeneity in the effect of tumor size on all these meta-analyses, with p < 0.10 and I² generally >50%. Subgroup analyses illustrated that the association of tumor size with adverse prognosis in UTUC patients is not affected by treatment modalities. Segmental resection of ureter, whether receiving lymph node dissection, cutoff of tumor size, and region of population were potential sources of heterogeneity. The funnel plot test indicated no significant publication bias in the meta-analysis of survival outcomes.

Conclusions: This study shows that larger tumor size is associated with an increased risk of overall and cancer-specific mortality, and disease recurrence in UTUC. Integration of tumor size with other prognostic indicators may help in risk stratification and individualized treatment of UTUC.

Patient summary: Through a systematic review and meta-analysis, this study found that larger tumor size is associated with an increased risk of overall and cancer-specific mortality, and disease recurrence in patients with upper tract urothelial carcinoma.

Keywords: Meta-analysis; Prognosis; Tumor size; Upper tract urothelial carcinoma.

Publication types

Review