Multiple Versus Single Intravesical Chemotherapy For Preventing The Intravesical Recurrence After Radical Nephroureterectomy For Upper Urinary Tract Urothelial Carcinoma

Background:Intravesical recurrence(IVR)is common after radical nephroureterectomy(RNU)in patients of upper urinary tract urothelial carcinoma(UTUC).Prophylactic single intravesical chemotherapy(SIC)or multiple intravesical chemotherapy(MIC)after RNU were both proven to decrease the occur of IVR.Although there are guidelines recommending SIC as the first choice,some studies have shown that MIC is more effective than SIC in preventing postoperative IVR in patients of UTUC.Currently,there is still controversy on the choice of MIC and SIC.Objective:To compare the effect of MIC and SIC on preventing IVR after RNU in UTUC patients.Method:Systematical search was performed on Pub Med,Embase,Web of Science,Cochrane library,Clinical Trials.gov,VIP,China knowledge network and Wan Fang database.The time was limited from the establishment of the database to September 2020.According to the inclusion and exclusion criteria,the studies that focus on comparing the prophylactic effect of MIC and SIC in postoperative IVR in UTUC patients were screened.The study selection,data extraction and quality assessment were completed by two authors independently.Review manager 5.4software was used for statistics analysis.Result:A total of 917 patients diagnosed with UTUC from 6literatures were included,of which 432 were in MIC group and 485 in SIC group.The patients were included from January 2000 to January 2019.Postoperative IVR was found in 183(19.96%)patients,of which 68 were in MIC group and 115 in SIC group.The Meta analysis result showed that the MIC group had lower risk than the SIC group on postoperative IVR(OR:0.58,95%CI:0.30-1.00,P=0.05,I~2=50%).After confirming and excluding heterogeneous source literature using the method of removing individual study,the pooled result had statistical difference(OR:0.51,95%CI:0.33-0.78,P=0.002,I~2=21%).As for the side effect of intravesical chemotherapy,the pooled results showed that the MIC group had higher risk than the SIC group,but there was no statistical difference(OR:3.32,95%CI:0.76-14.42,P=0.11,I~2=0%).The survival data can’t be analyzed due to lack of information.Conclusion:Compared with single intravesical chemotherapy after surgery,multiple intravesical chemotherapy is more effective in preventing IVR after RNU in UTUC patients,without increasing the side effect risk of intravesical chemotherapy.At present,the quality of related research is low,more high quality,large sample,prospective,multi-center and randomized controlled studies are urgently needed.