Exploring the association between urolithiasis and kidney cancer and upper tract urothelial carcinoma: A systematic review and meta-analysis of risk factors and patient characteristics

Abstract

Urolithiasis is a prevalent condition with rising incidence, with studies suggest.ing a possible link between kidney stones and an elevated risk of renal cell carcinoma (RCC) and upper tract urothelial carcinoma (UTUC), This systematic review and meta-analysis synthesizes evidence on whether urolithiasis is associated with an increased risk of kidney cancer. To address this, a comprehensive literature search of PubMed, Google Scholar, Web of Science, and ProQuest was performed for articles published between January 2000 and October 2023. Observational and cohort studies assessing patients with a history of urolithiasis and a diagnosis of RCC or UTUC were included, with two reviewers independently extracting data and evaluating the risk of bias using the Newcastle–Ottawa Scale and NIH quality assessment tools. A random-effects model was employed to calculate the pooled risk ratios (RRs), with heterogeneity assessed by I ² . Ultimately, fourteen studies encompassing 7,964 individuals met the inclusion criteria; within this group, male patients predominated (mean age 65.3 years) and common comorbidities included hypertension and diabetes, while frequent risk factors were smoking, nonsteroidal anti-inflammatory drug use, and obesity. The meta-analysis demonstrated an increased risk of kidney cancer among individuals with urolithiasis (pooled OR 1.76; 95% confidence interval: 1.49–2.07; P = 0.230). Heterogeneity analysis revealed substantial variability among the studies, with an I2 value of 72.2% ( P = 0.0273). These findings indicate that there is an increased association of RCC and UTUC in urolithiasis patients, suggesting that stone-forming patients, particularly those with additional risk factors, may require enhanced clinical surveillance.