Prognostic effects of different nephroureterectomy techniques for upper urinary tract urothelial carcinoma: a network meta-analysis

Abstract

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) is an aggressive malignant tumor, with surgical intervention as the primary treatment. This study evaluates the prognostic effects of laparoscopic radical nephroureterectomy (LNU), open radical nephroureterectomy (ONU), robot-assisted laparoscopic radical nephroureterectomy (Robotic LNU), and hand-assisted laparoscopic radical nephroureterectomy (Hand LNU) in the treatment of UTUC through a network meta-analysis. METHODS: A systematic search of the PubMed, EMBASE, Cochrane, and Web of Science databases was conducted for randomized controlled trials meeting the criteria from database inception until April 2024. Bayesian network meta-analysis was performed to compare the effects of each surgical method on overall survival (OS), cancer-specific survival (CSS), and overall recurrence rate (ORE). RESULTS: Seventeen randomized controlled trials were included in this network meta-analysis. The results indicated that LNU significantly improved CSS compared to ONU [HR = 0.81, 95%CI= (0.7, 0.93)], while there were no significant differences between Hand LNU and Robotic LNU compared to ONU. Among minimally invasive surgeries, Hand LNU significantly shortened CSS compared to LNU [HR = 1.49, 95%CI=(1.1, 2.03)]. Regarding ORE, no significant differences were found between LNU, Hand LNU, and Robotic LNU compared to ONU, although LNU had a higher recurrence rate than Robotic LNU [HR = 1.705, 95%CI=(1.007, 3.001)]. For OS, both LNU [HR = 0.84, 95%CI=(0.75, 0.94)] and Robotic LNU [HR = 0.81, 95%CI=(0.68, 0.96)] were significantly better than ONU, whereas Hand LNU significantly shortened OS compared to LNU and Robotic LNU. There were no significant differences in progression-free survival (PFS) between LNU and ONU. The cumulative efficacy ranking indicated that Robotic LNU ranked highest for ORE and OS, while LNU ranked first for CSS. CONCLUSION: Robotic LNU demonstrates advantages in prolonging OS and reducing recurrence rates, while LNU excels in improving CSS. Although Hand LNU shows suboptimal effects in some comparisons, it remains valuable, and surgical choices should be based on individualized needs.