TY - JOUR
T1 - A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma
T2 - Implications for the COVID19 pandemic and beyond
AU - On behalf of the UroSoMe Collaborators
AU - Leow, Jeffrey J.
AU - Tan, Wei Shen
AU - Tan, Wei Phin
AU - Tan, Teck Wei
AU - Chan, Vinson Wai Shun
AU - Tikkinen, Kari A.O.
AU - Kamat, Ashish
AU - Sengupta, Shomik
AU - Meng, Maxwell V.
AU - Shariat, Shahrokh
AU - Roupret, Morgan
AU - Decaestecker, Karel
AU - Vasdev, Nikhil
AU - Chong, Yew Lam
AU - Enikeev, Dmitry
AU - Giannarini, Gianluca
AU - Ficarra, Vincenzo
AU - Teoh, Jeremy Yuen Chun
N1 - Publisher Copyright:
2022 Leow, Tan, Tan, Tan, Chan, Tikkinen, Kamat, Sengupta, Meng, Shariat, Roupret, Decaestecker, Vasdev, Chong, Enikeev, Giannarini, Ficarra and Teoh.
PY - 2022/10/4
Y1 - 2022/10/4
N2 - Purpose: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC. Methods: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. Results: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery. Conclusions: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.
AB - Purpose: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC. Methods: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. Results: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery. Conclusions: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.
KW - bladder cancer
KW - bladder carcinoma
KW - delay in surgery
KW - delayed treatment
KW - time-to-treatment
KW - ureteral neoplasms
KW - urinary bladder neoplasms
KW - urothelial carcinoma
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UR - http://www.scopus.com/inward/citedby.url?scp=85140878965&partnerID=8YFLogxK
U2 - 10.3389/fsurg.2022.879774
DO - 10.3389/fsurg.2022.879774
M3 - Review article
C2 - 36268209
AN - SCOPUS:85140878965
SN - 2296-875X
VL - 9
JO - Frontiers in Surgery
JF - Frontiers in Surgery
M1 - 879774
ER -