A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond
Year: 2022
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: 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.
Source: Frontiers in Surgery
Authors: Jeffrey J. Leow, Wei Shen Tan, Wei Phin Tan, Teck Wei Tan, Vinson Wai-Shun Chan, Kari A. O. Tikkinen, Ashish Kamat, Shomik Sengupta, Maxwell V. Meng, Shahrokh Shariat, Morgan Roupret, Karel Decaestecker, Nikhil Vasdev, Yew Lam Chong, Dmitry Enikeev, Gianluca Giannarini, Vincenzo Ficarra, Jeremy Yuen-Chun Teoh, On behalf of the UroSoMe Collaborators
Institutions: Nanyang Technological University, Tan Tock Seng Hospital, University College Hospital, NYU Langone Health, University College London, University of Leeds, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, University of Helsinki, Helsinki University Hospital, South Karelia Central Hospital, The University of Texas MD Anderson Cancer Center, Eastern Health, Monash University, University of California, San Francisco, Al-Ahliyya Amman University, Charles University, Comprehensive Cancer Center Vienna, Weill Cornell Medicine, Medical University of Vienna, The University of Texas Southwestern Medical Center, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Onco-Urologie Prédictive, Ghent University Hospital, Ghent University, AZ Maria Middelares, University of Hertfordshire, Lister Hospital, Sechenov University, Ospedale Santa Maria della Misericordia di Udine, University of Messina, Chinese University of Hong Kong, European Association of Urology, Prince of Wales Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,490
OpenAlex ID: W4301396694