诊断性输尿管镜检查对上尿路上皮癌患者肿瘤复发及生存率影响的Meta分析

发布时间：2018-05-17 11:26

本文选题：输尿管镜检查 + 上尿路尿路上皮肿瘤　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:探究在上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)根治术前行诊断性输尿管镜检查(ureteroscopy,URS)是否对UTUC患者肿瘤复发及生存率产生影响。方法:检索在中、英文公开发表的前瞻性或回顾性试验,计算机检索Pub Med、EMbase、Cochrane Library、万方、中国知网数据库,检索时间从建库至2017年2月1日,查找所有URS对UTUC肿瘤复发及生存率影响的前瞻性或回顾性研究,按纳入、排除标准由两人独立进行文献纳入、资料提取和质量评价后,采用Cochrane协作网提供的Stata 12软件进行Meta分析。结果:共纳入16个研究,包括7185例患者。对肿瘤无复发生存风险进行多因素合并结果分析,由于所纳入文章异质性较大(I2=52.1%,P=0.010),考虑所纳入文章对肿瘤复发位置缺少准确的定位,对肿瘤复发位置进行分层,由于相关文献较少,无法进行膀胱肿瘤复发及膀胱外肿瘤复发亚组分组,仅分为膀胱肿瘤复发亚组(I2=39.2%,P=0.097)及肿瘤复发亚组(包括腹膜后复发,对侧上尿路复发及膀胱复发)(I2=16.4%,P=0.310),结果显示术前行URS增加肿瘤无复发生存风险[HR=1.39,95%CI(1.17,1.66)],特别对于膀胱肿瘤复发,行URS增加膀胱内无复发生存风险[HR=1.60,95%CI(1.33,1.94)],单因素合并结果显示行URS未增加肿瘤无复发生存风险[HR=1.11,95%CI(0.89,1.38)],但其中膀胱肿瘤复发亚组行URS增加膀胱内无复发生存风险[HR=1.33,95%CI(1.07,1.67)];多因素合并结果显示对于肿瘤特异生存期,行URS未增加肿瘤特异生存期的生存风险[HR=0.78,95%CI(0.60,1.62)],而单因素合并结果显示行URS组优于未行URS组[HR=0.69,95%CI(0.54,0.87)];行URS对总体生存风险没有影响,单因素合并结果差异没有统计学意义[HR=1.01,95%CI(0.63,1.62)]。结论:术前行URS增加肿瘤复发风险,特别是膀胱肿瘤复发,并未影响UTUC患者术后肿瘤特异生存期及总体生存风险。
[Abstract]:Objective: To explore the effect of diagnostic ureteroscopy (ureteroscopy, URS) on the recurrence and survival of UTUC patients before radical resection of upper tract urothelial carcinoma (UTUC). Methods: a prospective or retrospective study published in English, and a computer retrieval of Pub Med, EMbase, Cochr. Ane Library, Wanfang, China knowledge network database, search time from construction to February 1, 2017, look up all URS for UTUC tumor recurrence and survival rate of prospective or retrospective study. According to inclusion, the exclusion criteria are included by two people independently, after the data extraction and quality evaluation, the Stata 12 software provided by Cochrane collaboration network is used. Meta analysis. Results: a total of 16 studies, including 7185 patients, were included in the multiple factors analysis of the tumor free survival risk. Due to the larger heterogeneity of the articles (I2=52.1%, P=0.010), the lack of accurate location of the tumor recurrence location and the stratification of the tumor recurrence were considered, due to Xiang Guanwen Subgroups of bladder tumor recurrence and recurrence of bladder tumor recurrence were divided into subgroup of bladder tumor recurrence (I2=39.2%, P=0.097) and tumor recurrence subgroup (including retroperitoneal recurrence, retroperitoneal recurrence and bladder recurrence) (I2=16.4%, P=0.310), and URS increased the risk of tumor free survival [HR=1.39,95%CI before URS. (1.17,1.66), especially for the recurrence of bladder tumor, URS increased the risk of recurrence free survival in the bladder [HR=1.60,95%CI (1.33,1.94)]. The single factor combined results showed that URS did not increase the recurrence risk [HR=1.11,95%CI (0.89,1.38) of the tumor, but the recurrent subgroup of bladder tumor increased the risk of recurrence free survival in the bladder (0.89,1.38). 1.07,1.67)] the results of multi factor combination showed that URS did not increase the survival risk of tumor specific survival ([HR=0.78,95%CI (0.60,1.62)) for tumor specific survival period, and the single factor combined results showed that URS group was better than the non URS group [HR=0.69,95%CI (0.54,0.87)], and URS had no effect on the overall survival risk, and the single factor merger results had no difference. There was a statistically significant [HR=1.01,95%CI (0.63,1.62)] conclusion: URS increased the risk of tumor recurrence before operation, especially the recurrence of bladder tumor, which did not affect the tumor specific survival and overall survival risk of UTUC patients after operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.1

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