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Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis

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  • Zhaowei Zhu
  • Jia Zhao
  • Yinghui Li
  • Chen Pang
  • Zhanwei Zhu
  • Xuepei Zhang

Abstract

Background: Hydronephrosis is a common finding in patients with bladder cancer. The aim of the study was to appraise the prognostic value of preoperative hydronephrosis in bladder cancer patients undergoing radical cystectomy. Methods: We conducted a literature search using PubMed and Embase databases in Aug 2018. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effects models. The primary endpoint was overall survival (OS). Secondary endpoints were cancer-specific survival (CSS) and recurrence-free survival (RFS). Results: Overall, 13 studies published between 2008 and 2018 including 4,820 patients were selected for the meta-analysis. The age of bladder cancer patients ranged from 27 to 90.4 years, and the overall proportion of males was 72.5%. Preoperative hydronephrosis was reported in 27.4% of patients. The pooled HR was statistically significant for OS (HR, 1.36; 95% CI [1.20–1.55]) and CSS (HR, 1.64; 95% CI [1.33–2.02]), with no heterogeneity among the enrolled studies. Patients with bilateral hydronephrosis showed a poorer CSS compared to those with no hydronephrosis (HR 5.43, 95% CI [3.14–9.40]). However, there was no difference in CSS between no hydronephrosis and unilateral hydronephrosis groups (HR 1.35, 95% CI [0.84–2.14]). Despite a tendency towards poorer RFS (HR, 1.27; 95% CI [0.96–1.96]), the results demonstrated no significant association between presence of preoperative hydronephrosis and RFS after radical cystectomy. Conclusion: This meta-analysis indicates that preoperative hydronephrosis is significantly associated with poorer OS and CSS after radical cystectomy for patients with bladder cancer. Preoperative hydronephrosis has a stronger effect on CSS in patients with bilateral hydronephrosis. The presence of preoperative hydronephrosis not only predicts prognosis, but may also help to identify patients who benefit the most from neoadjuvant chemotherapy.

Suggested Citation

  • Zhaowei Zhu & Jia Zhao & Yinghui Li & Chen Pang & Zhanwei Zhu & Xuepei Zhang, 2019. "Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-12, September.
    • Handle: RePEc:plo:pone00:0222223
    DOI: 10.1371/journal.pone.0222223
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    References listed on IDEAS

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    1. Zhaowei Zhu & Xiaohua Zhang & Zhoujun Shen & Shan Zhong & Xianjin Wang & Yingli Lu & Chen Xu, 2013. "Diabetes Mellitus and Risk of Bladder Cancer: A Meta-Analysis of Cohort Studies," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-9, February.
    2. Ross J. Harris & Michael J. Bradburn & Jonathan J. Deeks & Roger M. Harbord & Douglas G. Altman & Jonathan A. C. Sterne, 2008. "metan: fixed- and random-effects meta-analysis," Stata Journal, StataCorp LLC, vol. 8(1), pages 3-28, February.
    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    4. Xin Xu & Jian Wu & Yeqing Mao & Yi Zhu & Zhenghui Hu & Xianglai Xu & Yiwei Lin & Hong Chen & Xiangyi Zheng & Jie Qin & Liping Xie, 2013. "Diabetes Mellitus and Risk of Bladder Cancer: A Meta-Analysis of Cohort Studies," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-8, March.
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