Supplementary Material for: Management of Obstructive Uropathy Patients with Advanced Prostate Cancer – A Systematic Review

Background: The optimal management of malignant ureteral obstruction in prostate cancer patients remains under debate and there exist no evidence-based recommendations to assist clinicians in advising patients. Material and Methods: Four databases were searched for the best available evidence for the treatment of ureteral obstruction and subsequent obstructive uropathy in prostate cancer regarding efficacy, overall survival and side effects. Treatment options considered were percutaneous nephrostomy (PCN), retrograde stenting and androgen deprivation (AD). The retrieved publications were screened for inclusion and exclusion criteria and assessed for methodological quality. Results: Of 987 identified publications, 13 were included in the review. The identified evidence consists of 3 cohort studies and 10 case series. More data and higher rates of successful decompression are published for PCN than for internal stenting. The results show inferior overall survival in patients pretreated with AD and high response rates for hormone-naive patients when treated with AD. There are no consistent results regarding the influence of unilateral or bilateral obstruction on overall survival. Conclusions: Various methodological flaws reduce the validity and generalisability of these results. There is currently no scientific evidence allowing for a reliable answer to the optimal management of malignant ureteral obstruction in prostate cancer patients.

背景：前列腺癌患者合并恶性输尿管梗阻的最优管理方案仍存在争议，目前尚无基于证据的推荐意见可供临床医师为患者提供诊疗建议。材料与方法：通过检索4个数据库，搜集前列腺癌患者输尿管梗阻及继发梗阻性肾病的治疗相关现有最佳证据，涵盖疗效、总生存期与不良反应三个维度。本次研究纳入的治疗方案包括经皮肾造瘘术（percutaneous nephrostomy, PCN）、逆行支架置入术以及雄激素剥夺治疗（androgen deprivation, AD）。对检索得到的文献按照纳入与排除标准进行筛选，并对其方法学质量进行评估。结果：本研究共检索到987篇文献，最终纳入13篇进行综述。纳入的证据包括3项队列研究与10项病例系列研究。相较于内支架置入术，经皮肾造瘘术的相关研究数据更为丰富，且梗阻减压成功率更高。研究结果显示，接受过雄激素剥夺治疗预处理的患者总生存期更短，而未接受过内分泌治疗的患者采用雄激素剥夺治疗时应答率较高。关于单侧或双侧输尿管梗阻对总生存期的影响，目前尚无一致结论。结论：多项方法学缺陷降低了本综述结果的有效性与外推性。目前尚无科学证据可为前列腺癌患者恶性输尿管梗阻的最优管理方案提供可靠依据。