Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor: a systematic review and meta-analysis

作者全名："Li, Shan; Wang, Jinkui; Li, Mujie; Zhang, Zhaoxia; Mi, Tao; Wu, Xin; Wang, Zhang; Jin, Liming; He, Dawei"

作者地址："[Li, Shan; Wang, Jinkui; Li, Mujie; Zhang, Zhaoxia; Mi, Tao; Wu, Xin; Wang, Zhang; Jin, Liming; He, Dawei] Chongqing Med Univ, Dept Urol, Childrens Hosp, Zhongshan 2nd Rd 136, Chongqing 400014, Peoples R China; [Li, Shan; Wang, Jinkui; Li, Mujie; Zhang, Zhaoxia; Mi, Tao; Wu, Xin; Wang, Zhang; Jin, Liming; He, Dawei] Chongqing Key Lab Children Urogenital Dev & Tissue, Chongqing 400014, Peoples R China; [Li, Shan; Wang, Jinkui; Li, Mujie; Zhang, Zhaoxia; Mi, Tao; Wu, Xin; Wang, Zhang; Jin, Liming; He, Dawei] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Chongqing Key Lab Pediat, Minist Educ,Key Lab Child Dev & Disorders,Children, Chongqing 400014, Peoples R China"

通信作者："He, DW (通讯作者)，Chongqing Med Univ, Dept Urol, Childrens Hosp, Zhongshan 2nd Rd 136, Chongqing 400014, Peoples R China.; He, DW (通讯作者)，Chongqing Key Lab Children Urogenital Dev & Tissue, Chongqing 400014, Peoples R China.; He, DW (通讯作者)，Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Chongqing Key Lab Pediat, Minist Educ,Key Lab Child Dev & Disorders,Children, Chongqing 400014, Peoples R China."

来源：PEDIATRIC SURGERY INTERNATIONAL

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001131693900001

JCR分区：Q2

影响因子：1.5

年份：2023

卷号：40

期号：1

开始页：　

结束页：　

文献类型：Review

关键词：Wilms tumor; Nephron-sparing surgery; Radical nephrectomy; Pediatric cancer; Renal function; Systematic review and meta-analysis

摘要："To evaluate the efficiency and long-term renal function of nephron sparing surgery (NSS) in unilateral WT patients compared with radical nephrectomy (RN). The review was performed following Cochrane Handbook guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched five databases (Pubmed, Embase, Scopus, Web of Science and Cochrane) for studies reporting the efficiency and late renal function of NSS and/or RN on February 10, 2023. Comparative studies were evaluated by Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and RoB 2.0. Assessed outcomes included survival rate, relapse rate, eGFR, renal dysfunction and hypertension. 26 studies involving 10322 unilateral WT cases underwent RN and 657 unilateral WT cases underwent NSS were enrolled. Overall effect estimates demonstrated that NSS significantly increased eGFR at follow-up (SMD, 0.38; 95% CI 0.05-0.72; p = 0.025) compared to that at diagnosis, and RN did not significantly decrease eGFR at follow-up (SMD, - 0.33; 95% CI - 0.77-0.11; p = 0.142) compared to that at diagnosis. Moreover, no significant difference was found in outcomes of survivability (OR, 1.38; 95% CI 0.82-2.32; p = 0.226), recurrence (OR, 0.62; 95% CI 0.34-1.12; p = 0.114), eGFR at follow-up (SMD, 0.16; 95% CI - 0.36-0.69; p = 0.538), renal dysfunction (OR, 0.36; 95% CI 0.07-1.73; p = 0.200) and hypertension (OR, 0.17; 95% CI 0.03-1.10; p = 0.063). Current evidence suggests that NSS is safe and effective for unilateral WT patients, because it causes better renal function and similar oncological outcomes compared with RN. Future efforts to conduct more high-quality studies and explore sources of heterogeneity is recommended."

基金机构：Chongqing Municipal Health Commission

基金资助正文：No Statement Available