Hanzhang Wang

Efficacy of bacillus Calmette-Guérin Strains for Treatment of Nonmuscle Invasive Bladder Cancer: A Systematic Review and Network Meta-Analysis

Purpose: We sought to determine the efficacy of genetically distinct bacillus Calmette‐Guérin strains in preventing disease recurrence in patients with nonmuscle invasive bladder cancer. Materials and Methods: We conducted a systematic review and network meta‐analysis of trials evaluating bacillus Calmette‐Guérin strains against all possible comparators (different bacillus Calmette‐Guérin strains, chemotherapy and nonbacillus Calmette‐Guérin biological therapies) with intravesical chemotherapy as the common comparator. MEDLINE® (http://www.ncbi.nlm.nih.gov/pubmed) served as the primary data source, with the search from inception to October 2016 for clinical trials involving patients with nonmuscle invasive bladder cancer receiving bacillus Calmette‐Guérin. Primary outcome measure was bladder cancer recurrence, defined as recurrent bladder tumor of any grade or stage. Random effect network meta‐analysis provided estimates for outcomes and is presented as odds ratios. Results: Across all possible comparators (65 trials, 12,246 patients, 9 strains) there were 2,177 recurrences in 5,642 treated patients (38.6%) and 2,316 recurrences in 5,441 comparators (42.6%). With chemotherapy as the common comparator (28 trials, 5,757 patients, 5 strains) Tokyo‐172 (OR 0.39, 95% CI 0.16–0.93), Pasteur (OR 0.49, 95% CI 0.28–0.86) and TICE® (OR 0.61, 95% CI 0.40–0.93) strains were significantly better than chemotherapy at preventing recurrence. No bacillus Calmette‐Guérin strain demonstrated significant superiority when compared to any other strain at preventing recurrence in the network meta‐analysis. Conclusions: Bacillus Calmette‐Guérin strains exhibited significant differences in efficacy compared to chemotherapy. However, no definitive conclusions could be reached regarding strain superiority, and head‐to‐head trials are greatly needed to further understand the importance of strain selection in determining bacillus Calmette‐Guérin efficacy.

Clinicopathological and Prognostic Value of Ki-67 Expression in Bladder Cancer: A Systematic Review and Meta-Analysis.

Background Ki-67 is an established marker of cell proliferation, and the Ki-67 index correlates with the clinical course of several cancer types, including bladder cancer (BC). However, the clinicopathological and prognostic significance of Ki-67 in bladder cancer remains unclear. Therefore, we performed a systematic review and meta-analysis to clarify this relationship. Methods A comprehensive literature search for relevant studies published up to February 1, 2016, was performed using PubMed, Cochrane Library, Embase and ISI Web of Knowledge. The effects of Ki-67 expression on survival outcome in patients with BC and BC subtypes were evaluated. Furthermore, the relationship between Ki-67 expression and the clinicopathological features of BC were assessed. Results Thirty-one studies with 5147 bladder cancer patients were selected for evaluation. Ki-67 expression was significantly associated with shorter recurrence-free (HR 1.69, 95% CI: 1.33–2.14), progression-free (HR 1.89, 95% CI: 1.43–2.51), overall (HR 2.03, 95% CI: 1.31–3.16), and cancer-specific (HR 1.69, 95% CI: 1.47–1.95) survival. Moreover, whereas high expression was more common in high tumor stage, recurrence status, tumor size, there was no correlation between high Ki-67 expression and age, gender, smoking habits, and tumor number. Importantly, analysis of the different subgroups of BC suggested that significant correlations between high Ki-67 expression and survival outcome (recurrence-free/progression-free/overall/cancer-specific survival) are present only in European-American patients. Conclusion The present results indicate that over-expression of Ki-67 is distinctly correlated with poor patient survival. Ki-67 may serve as a valuable biomarker for prognosis in BC patients, particularly in non-Asian BC patients. The results suggest no significant association between Ki-67 expression and BC prognosis in Asian patients. Further efforts are needed to fully clarify this relationship.

Clinical and Prognostic Effect of Plasma Fibrinogen in Renal Cell Carcinoma: A Meta-Analysis

Background. Although numerous studies have shown that plasma fibrinogen is linked to renal cell carcinoma (RCC) risk, the consistency and magnitude of the effect of plasma fibrinogen are unclear. The aim of the study was to explore the association between plasma fibrinogen and RCC prognosis. Methods. An electronic search of Embase, PubMed/MEDLINE, and the Cochrane databases was performed to identify relevant studies published prior to June 1, 2016. Results. A total of 3744 patients with RCC from 7 published studies were included in the meta-analysis. The prognostic and clinical relevance of plasma fibrinogen are evaluated in RCC patients. Statistical significance of the combined hazard ratio (HR) was detected for overall survival, cancer-specific survival, and disease-free survival. Our pooled results showed that elevated plasma fibrinogen was significantly associated with clinical stage and Fuhrman grading. The level of plasma fibrinogen was not found to be associated with tumor type and gender. Conclusions. Elevated plasma fibrinogen is a strong indicator of poorer prognosis of patients with RCC, whereas the plasma fibrinogen is not significantly associated with tumor type. Therefore, plasma fibrinogen could be used in patients with RCC for risk stratification and decision providing a proper therapeutic strategy.

Contemporary surgical outcomes of venous tumour thrombectomy managed with intraoperative Doppler ultrasound for kidney cancer

INTRODUCTION Radical nephrectomy (RN) with venous tumour thrombectomy (VTT) carries a significant morbidity and mortality risk. Examination of a contemporary single-institution series permits the development of a management algorithm and an audit its results. We report outcomes following the use of intraoperative colour Doppler ultrasound and our surgical pathway. METHODS We retrospectively reviewed the records of all patients who underwent RN with VTT for kidney cancer between January 1, 2013 and October 1, 2016. Surgical complications, postoperative complications (Clavien-Dindo classification ≥3), 90-day readmission rates, and outcomes are reported. Multivariate linear regression, logistic regression, and Cox proportional hazard modelling were used to identify associations. RESULTS Fifty-eight patients underwent RN with VTT. Of these, 26 (45%) patients had Mayo Clinic level III or IV thrombus and nineteen required venovenous/cardiopulmonary bypass. Three patients required patch grafting. The median length of hospital stay was eight days and there were 20 major complications. The 30-day readmission rate was 21% and the 90-day mortality rate was 8.9%. In multivariate analysis, low serum albumin and age-adjusted Charlson comorbidity score predicted length of stay. Increased intraoperative blood loss was significantly associated with increasing body mass index, serum creatinine, tumour thrombus level, and a history of significant weight loss >9.1kg. Low serum hematocrit predicted 90-day mortality. CONCLUSIONS Intraoperative colour Doppler ultrasound is a useful tool and can facilitate caval preservation. Caval grafting can be avoided in most cases. Venovenous bypass can be avoided in many level III cases. Early therapeutic anticoagulation should be instituted with caution.

MP100-01 PARTIAL NEPHRECTOMY VERSUS CRYOABLATION OR RADIOFREQUENCY ABLATION FOR CLINICAL STAGE T1 RENAL MASSES: SYSTEMATIC REVIEW AND META-ANALYSIS OF MORE THAN 3900 PATIENTS

INTRODUCTION AND OBJECTIVES: Conflicting data exist with regard to the outcomes of ablation procedures when compared with partial nephrectomy (PN) for cT1 renal masses. We compared allcause mortality (ACM), cancer-specific mortality (CSM), local recurrence (LR), distant metastases (DM), treatment-related complication rates, and post-procedure changes in estimated glomerular filtration rate (eGFR) between PN and ablation therapies. METHODS: We performed systematic review of original articles published upto July 2016. We conducted a meta-analysis to evaluate ACM, CSM, LR, DM rates, treatment-related complications and changes in eGFR. Publication bias was assessed using Begg and Egger tests. RESULTS: We identified 961 papers, of which 15 fulfilled our inclusion criteria. These 15 studies represented 3974 patients who had undergone an ablative procedure (CA or RFA; n 1⁄4 1455, 37%) or PN (n 1⁄4 2519, 63%). ACM and CSM rates were higher for ablation than for PN (HR 2.11 [95% CI 1.54-2.87], p < 0.05; HR 3.84 [95% CI 1.66-8.88], p < 0.05 respectively). No statistically significant difference in LR rate or risk of DM was seen between ablation and PN (HR 1.32 [95% CI 0.792.22], p 1⁄4 0.22 and HR 1.83 [95% CI 0.67-5.01], p 1⁄4 0.23, respectively). Complication rates were lower for ablation than for PN (13% versus 17.6%, respectively; OR 0.49 [95% CI 0.25-0.94], p < 0.05). The overall difference in reduction of eGFR between the ablation and PN groups was -7.42 mL/min/1.73 m2 (95% CI -12.48, -2.36; p 1⁄4 0.04). CONCLUSIONS: In this up-to-date meta-analysis, ablation, when compared to PN was associated with higher ACM and CSM, but no differences were seen in rates of LR or DM. Ablation was associated with fewer complications and a smaller reduction in eGFR when compared with PN.