Prognostic value and efficacy valuation of postoperative intravesical instillation in primary urothelial carcinomas of upper urinary tract

Bladder tumor recurrence after surgery for upper urinary tract urothelial carcinoma (UUT-UC) is frequent. Intravesical instillation has been widely accepted as an effective way to prevent bladder tumor recurrence. We aimed to find whether postoperative instillation have benefits for bladder tumor recurrence of UUT-UC. A meta-analysis based on 6 studies from 5 publications was performed. Published literature from PubMed, EMBASE and Web of science was pooled and the hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to estimate the benefits. Conclusively, our results indicate a 62% benefit (HR = 0.38; 95% CI: 0.16-0.87) in recurrence free survival (RFS) among those treated with postoperative intravesical instillation compared with those not. Mitomycin C (MMC) and pirarubicin were found to provide more benefits than other regimens in stratified analysis. Further, after excluding one study for its heterogeneity, the results demonstrated a more reliable results of a 34% benefit (HR = 0.66; 95% CI = 0.44-0.98). This study reveals a relative benefit for postoperative instillation to improve the RFS of UUT-UC patients.