Background
Methods
Literature search strategy
Inclusion and exclusion criteria
Data extraction and quality assessments
Statistical analysis
Results
Search and eligible studies
Characteristics of the included studies
Study | Country | Recruitment period | No. of patients | Age (years) | Gender (m/f) | Follow-up (months) | Study design | Survival analysis | Surgery |
---|---|---|---|---|---|---|---|---|---|
Xia et al.2017 [12] | China | 2005–2007 | 293 | Median (range) 55 (15–86) | 90/203 | Median (range) 99.1 (2.63–120.47) | Retrospective | OS,PFS | nephrectomy |
Wu et al.2017 [13] | China | 2004–2012 | 301 | Median (range) 53 (4–83) | 206/95 | Median (range) 51.6 (3–121) | Retrospective | OS | nephrectomy |
Niu et al.2017 [14] | China | 2008–2009 | 384 | Mean ± SD 53.9 ± 14.9 | 273/111 | Median (range) 73 (42–74) | Retrospective | OS,RFS | RN and PN |
Kim et al.2017 [15] | Korea | 2006–2012 | 177 | Mean ± SD 62 ± 10.9 | 136/41 | Median (range) 19.2 (0.2–63.8) | Retrospective | OS,PFS | nephrectomy |
Gu et al.2017 [16] | China | 2006–2014 | 184 | Mean ± SD 54.3 ± 13 | 142/42 | Mean ± SD 23.3 ± 14.6 | Retrospective | OS, PFS | nephrectomy |
Gershman et al.2017 [17] | USA | 1980–2010 | 138 | Mean (range) 63 (54–72) | 91/47 | Median (IQR) 102(67.2–130.8) | Retrospective | CSS, OS | RN and PN |
Chen et al.2017 [18] | China | 2006–2015 | 172 | Mean ± SD 56.5 ± 12.4 | 123/40 | Mean ± SD 34.4 ± 22.9 | Retrospective | CSS,RFS | RN |
Chang1 et al.2016 [19] | China | 2008–2014 | 233 | Median (IQR) 56(48–62) | 170/63 | Median (IQR) 68(41–71) | Retrospective | RFS | nephrectomy |
Volpe et al.2016 [3] | Italy | 2000–2010 | 308 | Median (IQR) 65(57–73) | 110/80 | Median (IQR) 72(39–108) | Retrospective | CSS | RN |
Khor et al.2016 [20] | USA | 1985–2003 | 842 | Median(range) 61.5(22.4–89) | 527/315 | Median (range) 73.2 (0.12–273.6) | Retrospective | OS | RN and PN |
NguyenHoang et al.2016 [21] | China | 2008–2009 | 392 | Mean ± SD 55.2 ± 12.1 | 116/276 | Median (range) 73 (39–74) | Retrospective | OS, RFS | RN and PN |
Errarte et al.2016 [22] | Spain | NA | 59 | Mean (range) 59 (25–83) | 45/14 | Mean (range) 65 (1–240) | Retrospective | OS | nephrectomy |
Byun et al.2016 [23] | Korea | 2000–2014 | 1284 | Mean ± SD 55.9 ± 12.9 | 913/371 | Median (IQR) 39(19–69) | Retrospective | CSS | RN and PN |
Huang et al.2015 [24] | China | 1991–2011 | 218 | Mean ± SD 58.9 ± 12.2 | 169/49 | Median (IQR) 43(17.8–67.5) | Retrospective | RFS | RN and PN |
Cornejo et al.2015 [25] | USA | 1984–2010 | 154 | Mean (range) 62.7 (26–86) | 125/29 | Mean (range) 73.9 (0.13–222) | Retrospective | CSS, OS | RN and PN |
Teng et al.2014 [26] | China | 2004–2009 | 378 | Mean ± SD 53.4 ± 12.4 | 272/106 | Median (range) 60 (2–97) | Retrospective | CSS, RFS | RN and PN |
Park et al.2014 [27] | Korea | 2006–2011 | 83 | Mean ± SD 56.3 ± 10.5 | 60/23 | Median (range) 18 (1–62) | Retrospective | OS, PFS | RN and PN |
Oliveira et al.2014 [28] | Brazil | 1988–2006 | 94 | Mean ± SD 59.7 ± 12.3 | 67/27 | Median 11.7 | Retrospective | CSS | RN and PN |
Can et al.2014 [29] | Turkey | 1995–2012 | 127 | Mean (range) 56 (26–80) | 70/57 | Mean (range) 46 (3–169) | Retrospective | CSS | RN and PN |
Pichler et al.2013 [30] | Austria | 2000–2010 | 994 | Mean ± SD 63.2 ± 11.9 | 599/395 | Mean (range) 48.1 (0–132) | Retrospective | CSS, OS | RN and PN |
Kruck et al.2013 [31] | Germany | 1993–2006 | 278 | Mean ± SD 62.2 ± 12.5 | 194/84 | Median (IQR) 65(20–100) | Retrospective | CSS, OS | RN and PN |
Fukatsu et al.2013 [32] | Japan | 1986–2008 | 561 | Median(range) 60(21–89) | 442/119 | Median (range) 55.7 (1–246) | Retrospective | CSS | nephrectomy |
Sukov et al.2013 [33] | USA | 1970–2002 | 395 | Median(range) 65(25–89) | 327/68 | NA | Retrospective | CSS | RN and PN |
Chang2 et al.2011 [34] | China | 2001–2006 | 328 | Mean (range) 59.2 (23–89) | 216/112 | Mean (range) 46.5 (1.0–97.2) | Retrospective | OS | RN and PN |
Leibovich et al.2010 [35] | USA | 1970–2003 | 3062 | NA | 2,0160/1002 | Median (range) 97.2 (0–432) | Retrospective | CSS | RN and PN |
Katz et al.2010 [36] | USA | 1989–2004 | 586 | Median 61 | 530/311 | Median (range) 61 (1–209) | Retrospective | CSS, OS | RN and PN |
Roos et al.2009 [37] | Germany | 1990–2006 | 118 | Mean (range) 64.5 (37.8–84.9) | 76/42 | Median (range) 3.2 (0.3–16.1) | Retrospective | CSS, PFS | nephrectomy |
Coons et al.2009 [38] | USA | 1988–2006 | 128 | Median(range) 64(35–87) | 95/33 | Median (range) 25.2 (0–124) | Retrospective | CSS, OS, RFS | nephrectomy |
Pflanz et al.2008 [39] | Germany | 1992–2006 | 607 | Mean (range) 61.6 (18–84) | 387/220 | Median 54 | Retrospective | CSS, OS | RN and PN |
Lee et al.2006 [40] | Korea | 1993–2003 | 485 | Median(range) 55(26–81) | 360/125 | Median(range) 50.9(1–148.6) | Retrospective | CSS | RN and PN |
Lam et al.2005 [41] | USA | 1989–2000 | 311 | Median(range) 62(27–89) | 208/103 | Median (range) 45 (0.3–117) | Retrospective | CSS | nephrectomy |
Tornberg et al.2016 [42] | Finland | 2006–2014 | 142 | Median(range) 65(41–89) | 95/47 | Median (range) 31 (0–111) | Prospective | CSS | RN and cytoreductive |
Schiavina et al.2015 [43] | Italy | 2000–2013 | 185 | Mean ± SD 63.3 ± 11.8 | 149/36 | Median (IQR) 32(18–62) | Prospective | CSS | RN and PN |
Ramsey et al.2008 [44] | UK | 2001–2005 | 83 | NA | 50/33 | Median 38 | Prospective | CSS, RFS | nephrectomy |
Study | Staging system | Grading system | TN+/TN- | Stage 1–2/ 3–4 | Grade 1–2/ 3–4 | ccRCC/no-ccRCC | Tumor size (cm) |
---|---|---|---|---|---|---|---|
Xia et al.2017 [12] | 2010 AJCC | Furman | 41/252 | 212/81 | 248/45 | 293/0 | NA |
Wu et al.2017 [13] | 2010 AJCC | Furman | 77/224 | 265/36 | 225/76 | 301/0 | NA |
Niu et al.2017 [14] | 2010 AJCC | Furman | 75/309 | 295/89 | 255/129 | 384/0 | Mean ± SD 4.1 ± 2.1 |
Kim et al.2017 [15] | 2009 AJCC | Furman | 46/131 | 60/82 | 44/105 | 159/3 | Median (range) 8 (1–117) |
Gu et al.2017 [16] | 2010 AJCC | Furman | 90/94 | NA | 70/94 | 161/23 | NA |
Gershman et al.2017 [17] | 2010 AJCC | WHO/ ISUP | 111/27 | 31/106 | 6/132 | 105/33 | Median (range) 10(8–13) |
Chen et al.2017 [18] | 2010 AJCC | Furman | 53/110 | 0/163 | 83/55 | 135/8 | Mean ± SD 6.8 ± 3.5 |
Chang1 et al.2016 [19] | 2010 AJCC | Furman | 182/51 | 169/64 | 135/96 | 233/0 | NA |
Volpe et al.2016 [3] | 2002 AJCC | Furman | 60/130 | 190/0 | 155/35 | 156/34 | Median (IQR) 4.9(3.5–7) |
Khor et al.2016 [20] | 2010 AJCC | Furman | 665/177 | 630/212 | 265/577 | 842/0 | Median (range) 4.2(0.6–20) |
NguyenHoang et al.2016 [21] | 2010 AJCC | Furman | 78/294 | 292/100 | 259/133 | 392/0 | Mean ± SD 4.3 ± 2.6 |
Errarte et al.2016 [22] | 2010 AJCC | Furman | 30/29 | 32/27 | 24/35 | 59/0 | Median (range) 7.9(2–19) |
Byun et al.2016 [23] | 2002 AJCC | Furman | 208/1076 | 1105/179 | 664/620 | 1114/170 | Mean ± SD 4.08 ± 2.68 |
Huang et al.2015 [24] | 2010 AJCC | Furman | 34/184 | 160/58 | 155/63 | 0/218 | Median (IQR) 3.5(2.5–6) |
Cornejo et al.2015 [25] | NA | Fuhrman/ ISUP | 40/114 | 121/33 | 103/51 | 0/154 | Mean (range) 5.1(0.4–17) |
Teng et al.2014 [26] | 2009 AJCC | Furman | 38/340 | 346/32 | 200/178 | 378/0 | Mean ± SD 4.6 ± 2.6 |
Park et al.2014 [27] | NA | Furman | 37/46 | NA | 13/70 | 83/0 | NA |
Oliveira et al.2014 [28] | 2010 AJCC | Furman | 18/76 | 77/17 | 65/29 | 94/0 | Mean ± SD 4.7 ± 2.6 |
Can et al.2014 [29] | 2010 AJCC | Furman | 42/85 | 84/43 | 72/55 | 127/0 | NA |
Pichler et al.2013 [30] | 2010 AJCC | Furman | 277/717 | 723/271 | 839 | 804/190 | NA |
Kruck et al.2013 [31] | 2010 AJCC | Furman | 114/164 | 169/109 | 234/44 | 278/0 | Mean ± SD 5.26 ± 2.91 |
Fukatsu et al.2013 [32] | 2010 AJCC | Furman | 57/104 | 508/53 | 341/220 | 561/0 | NA |
Sukov et al.2013 [33] | 2010 AJCC | Furman | 186/209 | 346/49 | 247/148 | 0/395 | NA |
Chang2 et al.2011 [34] | 2002 AJCC | Furman | 139/189 | 240/88 | 216/112 | 232/96 | NA |
Leibovich et al.2010 [35] | 2002 AJCC | Furman | 792/2090 | 1992/1070 | 1649/1413 | 1781/1281 | NA |
Katz et al.2010 [36] | 2002 AJCC | Furman | 253/586 | 575/194 | 589/252 | 641/198 | NA |
Roos et al.2009 [37] | 2002 AJCC | Furman | 10/108 | 0/118 | 63/55 | 109/16 | Median (range) 8(2.5–20) |
Coons et al.2009 [38] | 2002 AJCC | Furman | 57/71 | 0/128 | 40/103 | 105/23 | Median (range) 9.9 (3.5–21) |
Pflanz et al.2008 [39] | 2002WHO | Thoenes | 155/452 | 515/92 | 532/75 | 479/128 | NA |
Lee et al.2006 [40] | 1997 AJCC | Furman | 131/354 | 382/103 | 364/221 | 419/66 | NA |
Lam et al.2005 [41] | 1997 AJCC | Fuhrman | 168/143 | 157/153 | 186/119 | 270/41 | NA |
Tornberg et al.2016 [42] | 2009 AJCC | Furman | 84/58 | 0/132 | 38/104 | 129/13 | Mean ± SD 10.3 ± 3.6 |
Schiavina et al.2015 [43] | 2009 AJCC | Furman | 49/136 | 0/185 | 46/139 | 150/35 | Mean ± SD 8.05 ± 2.8 |
Ramsey et al.2008 [44] | 1997 AJCC | Furman | 55/28 | 48/35 | 37/40 | 33/50 | NA |
Prognostic value of TN for survival outcome
Analysis specification | No. of studies | Study heterogeneity | Effects model | Pooled HR(95% CI) | p-Value | |
---|---|---|---|---|---|---|
I2 (%) | Pheterogeneity | |||||
CSS | ||||||
Overall | 22 | 76.5 | < 0.001 | Random | 1.37(1.23,1.53) | < 0.001 |
Geographical region | ||||||
Asian | 7 | 51.7 | 0.053 | Random | 1.34(1.12,1.59) | 0.001 |
Other regions | 15 | 80.8 | < 0.001 | Random | 1.40(1.22,1.60) | < 0.001 |
Pathological types | ||||||
ccRCC | 6 | 0 | 0.775 | Fixed | 1.34(1.15,1.55) | < 0.001 |
Other types | 16 | 81.7 | < 0.001 | Random | 1.38(1.22,1.58) | < 0.001 |
Staging system | ||||||
2010 AJCC | 8 | 0 | 0.981 | Fixed | 1.30(1.17,1.44) | < 0.001 |
Other system | 14 | 82.3 | < 0.001 | Random | 1.42(1.23,1.64) | < 0.001 |
No. of patients | ||||||
≥ 300 | 13 | 82 | < 0.001 | Random | 1.39(1.21,1.61) | < 0.001 |
< 300 | 9 | 15,4 | 0.301 | Fixed | 1.33(1.16,1.51) | < 0.001 |
Median follow-up | ||||||
≥ 40 months | 12 | 83.3 | < 0.001 | Random | 1.36(1.16,1.60) | < 0.001 |
< 40 months | 9 | 30.2 | 0.177 | Fixed | 1.33(1.16,1.51) | < 0.001 |
OS | ||||||
Overall | 17 | 57.6 | 0.002 | Random | 1.29(1.20,1.40) | < 0.001 |
Geographical region | ||||||
Asian | 9 | 30.2 | 0.177 | Fixed | 1.38(1.25,1.51) | < 0.001 |
Other regions | 8 | 58.6 | 0.017 | Random | 1.20(1.09,1.34) | < 0.001 |
Pathological types | ||||||
ccRCC | 8 | 48.8 | 0.057 | Random | 1.33(1.19,1.49) | < 0.001 |
Other types | 9 | 62.7 | 0.006 | Random | 1.26(1.13,1.41) | < 0.001 |
Staging system | ||||||
2010 AJCC | 10 | 63.6 | 0.003 | Random | 1.30(1.17,1.44) | < 0.001 |
Other system | 7 | 53.1 | 0.046 | Random | 1.30(1.14,1.47) | < 0.001 |
No. of patients | ||||||
≥ 300 | 8 | 67.5 | 0.003 | Random | 1.25(1.12,1.39) | < 0.001 |
< 300 | 9 | 29.2 | 0.185 | Fixed | 1.35(1.22,1.49) | < 0.001 |
Median follow-up | ||||||
≥ 40 months | 13 | 62.6 | 0.001 | Random | 1.27(1.16,1.39) | < 0.001 |
< 40 months | 4 | 0 | 0.412 | Fixed | 1.37(1.20,1.56) | < 0.001 |
RFS | ||||||
Overall | 9 | 35.6 | 0.133 | Fixed | 1.55(1.39,1.72) | < 0.001 |
Geographical region | ||||||
Asian | 6 | 42.7 | 0.12 | Fixed | 1.48(1.31,1.66) | < 0.001 |
Other regions | 3 | 0 | 0.684 | Fixed | 1.87(1.41,2.37) | < 0.001 |
Pathological types | ||||||
ccRCC | 4 | 0 | 0.541 | Fixed | 1.61(1.40,1.86) | < 0.001 |
Other types | 5 | 57.5 | 0.051 | Random | 1.46(1.25,1.71) | < 0.001 |
Staging system | ||||||
2010 AJCC | 5 | 54 | 0.069 | Random | 1.48(1.31,1.69) | < 0.001 |
Other system | 4 | 0 | 0.483 | Fixed | 1.69(1.40,2.04) | < 0.001 |
No. of patients | ||||||
≥ 300 | 4 | 0 | 0.702 | Fixed | 1.57(1.35,1.83) | < 0.001 |
< 300 | 5 | 63.4 | 0.027 | Random | 1.52(1.32,1.76) | < 0.001 |
Median follow-up | ||||||
≥ 40 months | 6 | 0 | 0.758 | Fixed | 1.62(1.43,1.84) | < 0.001 |
< 40 months | 3 | 75.3 | 0.018 | Random | 1.39(1.16,1.68) | 0.001 |
PFS | ||||||
Overall | 5 | 32.9 | 0.202 | Fixed | 1.31(1.17,1.46) | < 0.001 |
Pathological types | ||||||
ccRCC | 2 | 67.8 | 0.078 | Random | 1.44(1.20,1.71) | < 0.001 |
Other types | 3 | 0 | 0.6 | Fixed | 1.23(1.07,1.41) | 0.004 |
Staging system | ||||||
2010 AJCC | 2 | 76.3 | 0.04 | Random | 1.35(1.18,1.54) | < 0.001 |
Other system | 3 | 0 | 0.582 | Fixed | 1.22(1.01,1.48) | 0.036 |