Delayed surgery for localised and metastatic renal cell carcinoma : a systematic review and meta-analysis for the COVID-19 pandemic
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature..
PURPOSE: The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era.
METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared.
RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43-0.86, p < 0.001).
CONCLUSION: Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
World journal of urology - 39(2021), 12 vom: 24. Dez., Seite 4295-4303 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chan, Vinson Wai-Shun [VerfasserIn] |
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| Links: |
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| Themen: |
Active surveillance |
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| Anmerkungen: |
Date Completed 23.11.2021 Date Revised 23.11.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00345-021-03734-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325809488 |
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| 100 | 1 | |a Chan, Vinson Wai-Shun |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Delayed surgery for localised and metastatic renal cell carcinoma |b a systematic review and meta-analysis for the COVID-19 pandemic |
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| 500 | |a Date Revised 23.11.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a PURPOSE: The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era | ||
| 520 | |a METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared | ||
| 520 | |a RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43-0.86, p < 0.001) | ||
| 520 | |a CONCLUSION: Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Active surveillance | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Delayed surgery | |
| 650 | 4 | |a Nephrectomy | |
| 650 | 4 | |a Renal cell carcinoma | |
| 650 | 4 | |a Targeted therapy | |
| 700 | 1 | |a Tan, Wei Shen |e verfasserin |4 aut | |
| 700 | 1 | |a Leow, Jeffrey J |e verfasserin |4 aut | |
| 700 | 1 | |a Tan, Wei Phin |e verfasserin |4 aut | |
| 700 | 1 | |a Ong, William Lay Keat |e verfasserin |4 aut | |
| 700 | 1 | |a Chiu, Peter Ka-Fung |e verfasserin |4 aut | |
| 700 | 1 | |a Gurung, Pratik |e verfasserin |4 aut | |
| 700 | 1 | |a Pirola, Giacomo Maria |e verfasserin |4 aut | |
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| 700 | 1 | |a Wang, Yuding |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, I-Hsuan Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Castellani, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Wroclawski, Marcelo Langer |e verfasserin |4 aut | |
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| 700 | 1 | |a Giannarini, Gianluca |e verfasserin |4 aut | |
| 700 | 1 | |a Teoh, Jeremy Yuen-Chun |e verfasserin |4 aut | |
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