Diagnostic Performance of Confocal Laser Endomicroscopy for the Detection of Bladder Cancer: Systematic Review and Meta-Analysis
作者：
Wu J.
Wang Y. C.
Luo W. J.
Dai B.
Ye D. W.
Zhu Y. P.
作者单位：
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Wahringer Gurtel 43 18-20, 1090, Vienna, Austria. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. Department of Urology, Medical University of Silesia, Zabrze, Poland. Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Urology, King Faisal Medical City, Abha, Saudi Arabia. Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. Department of Urology, University Hospital Zurich, Zurich, Switzerland. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Wahringer Gurtel 43 18-20, 1090, Vienna, Austria. shahrokh.shariat@meduniwien.ac.at. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. shahrokh.shariat@meduniwien.ac.at. Division of Urology, Department of Special Surgery, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan. shahrokh.shariat@meduniwien.ac.at. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. shahrokh.shariat@meduniwien.ac.at. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. shahrokh.shariat@meduniwien.ac.at. Department of Urology, Weill Cornell Medical College, New York, NY, USA. shahrokh.shariat@meduniwien.ac.at. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. shahrokh.shariat@meduniwien.ac.at.
归属分类：
膀胱肿瘤诊断证据
DOI：
10.27439/d.cnki.gybdu.2022.000143
关键词：
bladder cancer
hydronephrosis
lymph node invasion
stage
survival
PURPOSE: The currently available evidence regarding the prognostic and clinical significance of each variant histology subtype of urothelial bladder cancer remains scarce. We assessed the prognostic value of variant histology in patients with urothelial carcinoma of the bladder treated with radical cystectomy. MATERIALS AND METHODS: PubMed®, Web of Science™, Cochrane Library and Scopus® databases were searched for articles published before October 2019 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We identified 39 studies comprising 20,544 patients matching our eligibility criteria. RESULTS: Studies were deemed eligible if they compared overall, cancer specific and recurrence-free survival in patients with urothelial carcinoma of the bladder with and without variant histology. Formal meta-analyses were performed for these outcomes. Variant histology was associated with worse cancer specific (pooled HR 1.37, 95% CI 1.24-1.50), overall (pooled HR 1.44, 95% CI 1.26-1.65) and recurrence-free survival (pooled HR 1.32, 95% CI 1.20-1.45). Subgroup analyses demonstrated that `micropapillary` (pooled HR 1.20, 95% CI 1.02-1.41), `plasmacytoid` (pooled HR 2.03, 95% CI 1.17-3.52) and `small cell` variant histology (HR 3.32, 95% CI 1.98-5.59) were also associated with worse overall survival. CONCLUSIONS: Variant histology in patients with urothelial carcinoma of the bladder is associated with increased risks of disease recurrence as well as cancer specific and overall mortality. Variant histology was independently associated with overall survival in the `micropapillary,` `plasmacytoid` and `small cell` subgroups. Variant histology should be integrated into prognostic tools to guide risk stratification, treatment planning and patient counseling. However, caution should be exercised in interpreting the conclusions drawn from this study given the limitations, which include the heterogeneity of the population of interest and the retrospective nature of the primary data evaluated.