上尿路尿路上皮肿瘤根治术前输尿管镜检查对远期预后影响的Meta分析  

Long-term effect of ureteroscopy prior to radical nephroureterectomy for upper tract urothelial carcinoma: a meta-analysis

作　　者：张驌 王诚[1] 翟振兴[1] 王娟[1] 牛纪平 付生军[1] 王新平[1] 杨立[1] Zhang Su Wang Cheng Zhai Zhenxing Wang Juan Niu Jiping Fu Shengjun Wang Xinping Yang Li(Department of Urology, Lanzhou University Institute of Urology, Gansu Nephron-Urological Clinical Center, Gansu Provincial Key Laboratory of Urological System Diseases, Second Hospital of Lanzhou University, Lanzhou, Gansu Province, 730030, Chin)

机构地区：[1]兰州大学泌尿外科研究所,兰州大学第二医院泌尿外科,甘肃省泌尿系统疾病临床医学中心,甘肃省泌尿系统疾病研究重点实验室,兰州730030

出　　处：《第三军医大学学报》2017年第1期101-106,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81402122)~~

摘　　要：目的 Meta分析上尿路尿路上皮肿瘤(upper tract urothelial carcinoma,UTUC)根治手术前行输尿管镜检查(ureteroscopy,URS)对UTUC远期预后的影响。方法计算机检索Pub Med、EMbase、Cochrane Library、中国生物医学文献数据库、万方、维普和中国知网数据库,收集URS对UTUC预后影响的前瞻性或回顾性研究,检索时限为建库至2016年2月29日。由两名研究者按照纳入与排除标准进行文献纳入,对纳入的研究行质量评价,提取相关肿瘤预后资料风险比(hazard ratios,HR)及其95%可信区间(confidence interval,CI),采用Stata 12软件进行Meta分析。结果共纳入13个回顾性研究,包括4 105例患者。Meta分析结果显示:术前行URS未增加疾病无复发生存风险,单因素合并结果[HR=0.93,95%CI(0.73,1.13)],多因素合并结果[HR=1.13,95%CI(0.90,1.36)];行URS未增加膀胱内无复发生存风险,单因素合并结果[HR=1.13,95%CI(0.82,1.43)],多因素合并结果[HR=1.54,95%CI(0.97,2.12)];对于肿瘤特异生存期,单因素合并结果显示行URS组优于未行URS组[HR=0.68,95%CI(0.48,0.88)],而多因素合并结果两者差异无统计学意义[HR=0.83,95%CI(0.54,1.12)];行URS未增加总体生存风险,单因素合并结果差异无统计学意义[HR=0.87,95%CI(0.46,1.27)]。结论术前行URS并未影响UTUC患者术后远期肿瘤复发及生存情况。Objective To determine the effect of ureteroscopy （URS） prior to radical nephroureterectomy on the long-term prognosis in treatment of upper tract urothelial carcinoma （UTUC）. Methods Computer retrieval was carried out in PubMed, EMBase, Cochrane library, China Biology Medicine disc （CBM）, WanFang Data, VIP database, and China National Knowledge Infrastructure （CNKI） from establishment until February 29, 2016 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 our inclusion and exclusion criteria. The quality of the literature was assessed, and the extracted data was systematically analyzed for corresponding hazard ratios （HR） and 95% confidence interval （95%CI） by using Stata 12. Results Thirteen retrospective studies were eligible, including 4 105 patients. The pooled HR of recurrencefree survival （RFS） was not significant in the univariate analysis （HR=0.93, 95%CI： 0.73～1.13） or the multivariate analysis （HR=1.13, 95%CI： 0.90～1.36）. The pooled HR of intravesical recurrence-free survival （IRFS） was HR=1.13, 95%CI： 0.82～1.43 in the univariate analysis and HR=1.54, 95%CI： 0.97～2.12 in the multivariate analysis. The pooled HR of cancer specific survival （CSS） was significant in the univariate analysis （HR=0.68, 95%CI： 0.48～0.88）, but not in the multivariate analysis （HR=0.83, 95%CI： 0.54～1.12）. The pooled HR of overall survival （OS） was not significant in the univariate （HR=0.87, 95%CI： 0.46～1.27）. Conclusion Based on our meta-analysis of current evidence, the performance of URS prior to radical nephroureterectomy for UTUC has no adverse effect on longterm recurrence and survival.

关 键 词：上尿路尿路上皮肿瘤 输尿管镜检查 预后 

分 类 号：R181.23[医药卫生—流行病学] R730.49[医药卫生—公共卫生与预防医学]