Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta‐analysis

<jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate whether ureteroscopy (<jats:styled-content style="fixed-case">URS</jats:styled-content>) before radical nephroureterectomy (<jats:styled-content style="fixed-case">RNU</jats:styled-content>) for upper tract urothelial carcinomas (<jats:styled-content style="fixed-case">UTUC</jats:styled-content>s) has an impact on oncological outcomes.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>We performed a systematic literature search of PubMed, Web of Science, and <jats:styled-content style="fixed-case">EMBASE</jats:styled-content> for citations published prior to September 2017 that described <jats:styled-content style="fixed-case">URS</jats:styled-content> performed on patients with <jats:styled-content style="fixed-case">UTUC</jats:styled-content> and conducted a standard meta‐analysis on survival outcomes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Our meta‐analysis included eight eligible studies containing 3975 patients. The results were as follows: cancer‐specific survival (<jats:styled-content style="fixed-case">CSS</jats:styled-content>; hazard ratio [<jats:styled-content style="fixed-case">HR</jats:styled-content>] 0.76, 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] 0.59–0.99; <jats:italic>P</jats:italic> = 0.04), overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>;<jats:styled-content style="fixed-case"> HR</jats:styled-content> 0.76, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.48–1.21; <jats:italic>P</jats:italic> = 0.24), recurrence‐free survival (<jats:styled-content style="fixed-case">RFS</jats:styled-content>;<jats:styled-content style="fixed-case"> HR</jats:styled-content> 0.89, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.69–1.14; <jats:italic>P</jats:italic> = 0.37), metastasis‐free survival (<jats:styled-content style="fixed-case">MFS</jats:styled-content>;<jats:styled-content style="fixed-case"> HR</jats:styled-content> 1.06, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.82–1.36; <jats:italic>P</jats:italic> = 0.66), and intravesical recurrence‐free survival (<jats:styled-content style="fixed-case">IRFS</jats:styled-content>;<jats:styled-content style="fixed-case"> HR</jats:styled-content> 1.51, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.29–1.77; <jats:italic>P</jats:italic> < 0.001). When excluding previous bladder tumour history, the result for <jats:styled-content style="fixed-case">IRFS</jats:styled-content> was a <jats:styled-content style="fixed-case">HR</jats:styled-content> of 1.81 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.53–2.13; <jats:italic>P</jats:italic> < 0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This meta‐analysis indicated that <jats:styled-content style="fixed-case">URS</jats:styled-content> before <jats:styled-content style="fixed-case">RNU</jats:styled-content> did not have a negative impact on <jats:styled-content style="fixed-case">CSS</jats:styled-content>,<jats:styled-content style="fixed-case"> OS</jats:styled-content>,<jats:styled-content style="fixed-case"> RFS</jats:styled-content>, or <jats:styled-content style="fixed-case">MFS</jats:styled-content> in patients with <jats:styled-content style="fixed-case">UTUC</jats:styled-content>. However, patients were at higher risk of intravesical recurrence after <jats:styled-content style="fixed-case">RNU</jats:styled-content> when they had undergone <jats:styled-content style="fixed-case">URS</jats:styled-content> before <jats:styled-content style="fixed-case">RNU</jats:styled-content>. Further studies are needed to assess the effects of post‐<jats:styled-content style="fixed-case">URS</jats:styled-content> intravesical chemotherapy on intravesical recurrence.</jats:p></jats:sec>