Clinical Research Papers:

Perioperative treatments for resected upper tract urothelial carcinoma: a network meta-analysis

Xiao Yang, Peng Li, Xiaheng Deng, Hongquan Dong, Yidong Cheng, Xiaolei Zhang, Chengdi Yang, Jingyuan Tang, Wenbo Yuan, Xiaoting Xu, Jun Tao, Pengchao Li, Haiwei Yang, Qiang Lu, Min Gu _ and Zengjun Wang

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Oncotarget. 2017; 8:3568-3580. https://doi.org/10.18632/oncotarget.12239

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Xiao Yang1,*, Peng Li1,*, Xiaheng Deng1,*, Hongquan Dong2, Yidong Cheng1, Xiaolei Zhang1, Chengdi Yang1, Jingyuan Tang1, Wenbo Yuan1, Xiaoting Xu1, Jun Tao1, Pengchao Li1, Haiwei Yang1, Qiang Lu1, Min Gu1 and Zengjun Wang1

1 Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

2 Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

* These authors have contributed equally to this work

Correspondence to:

Qiang Lu, email:

Min Gu, email:

Keywords: upper tract urothelial carcinoma; perioperative treatment; network meta-analysis

Received: December 23, 2015 Accepted: September 20, 2016 Published: September 24, 2016


Background: Perioperative treatments have been used to improve prognosis in patients with upper tract urothelial carcinoma (UTUC). However, optimal management remains unestablished.

Methods: We searched the Embase, Web of Science and Cochrane databases for studies published before June 20, 2015. All included studies were categorised into three groups on the basis of the outcome reported (overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS)). Relative hazard ratios (HRs) for death were calculated using random-effects Bayesian network meta-analysis methods. We also ranked the three different treatments in terms of three outcomes.

Results: A total of 31 trials with 8100 patients were included. Compared with the control, adjuvant chemotherapy (AC) could improve OS, DSS and RFS by 32% (HR 0.68, 95% CI 0.51-0.89), 29% (HR 0.71, 95% CI 0.54-0.89) and 51% (HR 0.49, 95% CI 0.23-0.85), respectively. We noted a marked prolongation of RFS in both intravesical chemotherapy (HR 0.32, 95% CI 0.09-0.69) as well as concurrent radiotherapy and intravesical chemotherapy (HR 0.32, 95% CI 0.03-0.97) than in the control. Neoadjuvant chemotherapy (NAC) showed a significant improvement in DSS relative to the control (HR 0.25, 95% CI 0.06-0.61) and a distinct advantage over AC (HR 0.36, 95% CI 0.08-0.90) or AR (HR 6.89, 95% CI 1.25-18.66).

Conclusions: Our results showed that AC; intravesical chemotherapy; and concurrent radiotherapy and intravesical chemotherapy could improve the prognosis of UTUC patients. NAC was found to be more favourable for UTUC than AC in terms of DSS.

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