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The Role of Surgical Resection of the Primary Tumor in Metastatic Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis Publisher Pubmed



Kardoust Parizi M1, 2 ; Singla N3 ; Roupret M4 ; Margulis V5 ; Matsukawa A1, 6 ; Tsuboi I1, 7 ; Schulz R1, 8 ; Karakiewicz PI9 ; Teoh JYC10 ; Soria F11 ; Shariat SF1, 5, 11, 12, 13, 14, 15, 16
Authors
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Authors Affiliations
  1. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  2. 2. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, United States
  4. 4. Department of Urology, Pitie Salpetriere Hospital, AP-HP, GRC 5, Predictive Onco-Urology, Sorbonne University, Paris, France
  5. 5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
  6. 6. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
  7. 7. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
  8. 8. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  9. 9. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
  10. 10. Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  11. 11. Department of Urology, AOU Citta della Salute e della Scienza, Torino School of Medicine, Turin, Italy
  12. 12. Departments of Urology, Weill Cornell Medical College, New York, NY, United States
  13. 13. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  14. 14. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  15. 15. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
  16. 16. Research Center for Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz, Iran

Source: Current Opinion in Urology Published:2025


Abstract

Purpose of reviewTo evaluate the role of extirpative surgery for the primary tumor in metastatic upper tract urothelial carcinoma (mUTUC).Recent findingsThe PubMed, Web of Science, and Cochrane Library were searched on July 2024 to identify relevant studies according to the Preferred Reporting Items for Systematic Review (PRISMA) statement. Studies were eligible for analysis if they compared oncologic outcomes between mUTUC patients who underwent surgical resection of the primary tumor and patients who did not. Cancer-specific survival (CSS) and overall survival (OS) were assessed using multivariate logistic regression analyses. We identified 2686 reports, of which 11 articles comprising 12 833 records were selected for this systematic review. Eight and three studies used Surveillance Epidemiology and End Results (SEER) and National Cancer Database (NCDB) databases, respectively. Surgical resection of the primary tumor was significantly associated with better CSS and OS in patients with mUTUC. Among the 5353 mUTUC patients included in our meta-analysis, radical nephroureterectomy (RNU) was independently associated with better OS with a pooled hazard ratio (HR) of 0.62 [95% confidence interval (CI) 0.54-0.72, P-<-0.05]. Subgroup analyses of studies restricted to mUTUC patients with distant lymph node metastasis (n-=-1372) revealed RNU to be independently associated with better OS with pooled HR: 0.44 (95% CI 0.28-0.67, P-<-0.05) together with systemic chemotherapy, primary tumor site in the ureter, lower T stage, and no locoregional lymph node involvement.SummarySurgical resection of the primary tumor offers oncologic survival benefits in select patients with mUTUC. However, in the absence of data from prospective randomized studies, it is essential to evaluate each patient individually as part of a collaborative multidisciplinary shared decision working with the patient. © 2025 Wolters Kluwer Health, Inc. All rights reserved.
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