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广泛争议，目前尚无循证医学建议可协助临床医师为患者提供诊疗指导。
材料与方法：检索四个数据库，旨在获取针对前列腺癌相关输尿管梗阻及其继发梗阻性肾病的治疗在有效性、总生存期与不良反应方面的最佳可用证据。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）。对检索得到的文献进行纳入与排除标准筛选，并评估其方法学质量。
结果：共检索到987篇相关文献，最终纳入13篇进行系统综述。纳入的证据包含3项队列研究与10项病例系列研究。相较于内置支架置入术，经皮肾造瘘术的成功减压相关数据更为丰富，报道率也更高。研究结果显示，经雄激素剥夺治疗预处理的患者总生存期更短，而激素初治患者接受雄激素剥夺治疗后应答率较高。关于单侧或双侧梗阻对总生存期的影响，目前尚未获得一致结论。
结论：各项研究均存在多种方法学缺陷，削弱了本综述结果的有效性与临床外推性。目前尚无科学证据可对前列腺癌患者恶性输尿管梗阻的最优管理方案给出可靠解答。