Kidney-sparing Management Versus Nephroureterectomy for Upper Tract Urothelial Carcinoma: a Systematic Review and Meta-analysis

Purpose: To evaluate and update evidence for prognostic effects of kidney-sparing (KS) management andnephroureterectomy (NU) for upper tract urothelial carcinomas. Materials and
Methods: Pubmed, Embase andthe Cochrane Library were retrieved for the identification of comparative studies of kidney-sparing procedureand nephroureterectomy for upper tract urothelial carcinoma prior to December 2014. The data were extractedindependently by 2 reviewers and the quality of the included studies was assessed. Review Manager 5.3 and STATA13 were used to perform the meta-analysis.
Results: Twenty-three observational studies including 1,587 KS and3,996 NU were evaluated. The results of the meta-analysis showed that nephroureterectomy had no significantbenefit with regard to intravesical recurrence (IRFS), metastasis (MFS), cancer specific survival (CSS) and overallsurvival (OS) except the total tumor recurrence (RFS) when compared with kidney sparing management. Therespectively pooled outcomes were HR 1.36 (0.69-2.68, P=0.38) for IRFS, 1.09 (0.59-2.01, P=0.78) for MFS, 1.17(0.77-1.79, P=0.47) for CSS, 1.50 (0.90-2.48, P=0.12) for OS and 1.61 (1.03-2.51, P=0.04) for RFS.
Conclusions:On the whole, kidney-sparing management had equivalent prognostic effect on upper tract urothelial carcinomaas the standard nephroureterectomy except in tumor recurrence. However, the results should be interpreted withcaution for lack of stage and grade stratification and multi-center randomized controlled trials are still neededto verify our results.