Clinical Significance Of Lymph Node Dissection In Surgical Management Of Upper Tract Urothelial Carcinoma:A Meta Analysis

Background:There is considerable controversy in whether patients with upper tract urothelial carcinoma undergo lymph node dissection can benefit to patients from survival,during radical nephroureterectomy with bladder cuff resection.We will use this study to determine whether lymphatic dissection can provide survival benefits to patients.Method:We conducted a systematic literature search on foreign databases such as PubMed,Embase,Springer,Science Direct,Cochrane library,and Chinese databases such as CKNI,CBM,WANFANG data,and select all documents published before December 2018 about upper urinary tract urothelial carcinoma patients undergoing lymph node dissection.We performed quality assessment on the included literature and meta-analysis by RevMan 5.3 software.Result:We included 15 articles and 12,915 cases.The results show overall patients with no significant difference between LND and NLND in CSS and RFS(CSS:HR=1.25,95%CI[0.97,1.62],P = 0.09;RFS: HR=1.26,95%CI[0.83,1.91],P=0.27);no signific-ant difference between pN0 and pNx in CSS and RFS(CSS:HR=0.95,95%CI [0.82,1.09],P =0.45;RFS:HR=0.99,95%CI [0.59,1.66],P =0.97);but patients with pN+ showed poor CSS and RFS compared with those with pN0(CSS:HR=4.00,95%CI [2.85,5.62],P < 0.00001;RFS:HR=3.75,95%CI [2.29,6.15],P < 0.00001).In patients with muscle-invasive UTUC: no significant difference between LND and NLND in CSS and RFS(CSS:HR=1.02,95%CI[0.91,1.13],P=0.76;RFS:HR=1.26,95%CI[0.83,1.91],P=0.27);no significant difference between pN0 and pNx in RFS,but benefit to CSS(CSS:HR=0.74,95%CI[0.59,0.94],P=0.01;RFS:HR=0.80,95%CI[0.39,1.61],P=0.52);in contrast,pN+ showed poor CSS and RFS compared with those pN0(CSS:HR=3.62,95%CI [3.16,4.14],P < 0.00001;RFS:HR=2.14,95%CI [1.04,4.37],P=0.04).Conclusion:The true value of lymph node dissection requires further verification in upper tract urothelial carcinoma.We can accurately tumors stage by lymph node dissection,and provide evidence for follow-up treatment.Lymph node dissection can signific-antly improve patient survival reduce recurrence in patients with muscle-invasive upper tract urothelial carcinoma(pT2cN0M0).