ArticleTherapeutic advances in drug safety2021
Aristolochic acid-associated urinary tract cancers: an updated meta-analysis of risk and oncologic outcomes after surgery and systematic review of molecular alterations observed in human studies.
Article in Therapeutic advances in drug safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Adjuvant Radiotherapy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis.Current oncology (Toronto, Ont.) · 2022Pooled it
- Beyond Tradition: An Integrated Toxicological, Ecological, and Public Health Perspective on Aristolochic Acids.Journal of applied toxicology : JAT · 2026Review
- Long-Term Outcome of Kidney Transplant Patients from Rural Farming Areas with Balkan Nephropathy-A Single-Centre Report.Journal of clinical medicine · 2026Article
- Genomic subtypes of non-muscle-invasive bladder cancer: guiding immunotherapy decision-making for patients exposed to aristolochic acid.Molecular medicine (Cambridge, Mass.) · 2025Article
- Artificial intelligence algorithms enhance urine cytology reporting confidence in postoperative follow-up for upper urinary tract urothelial carcinoma.International urology and nephrology · 2025Article
- Same Organ, Two Cancers: Complete Analysis of Renal Cell Carcinomas and Upper Tract Urothelial Carcinomas.Medicina (Kaunas, Lithuania) · 2024Article
- Detection and Removal of Aristolochic Acid in Natural Plants, Pharmaceuticals, and Environmental and Biological Samples: A Review.Molecules (Basel, Switzerland) · 2023Review
- Enhanced Production of Nitrogenated Metabolites with Anticancer Potential inInternational journal of molecular sciences · 2023Article
- Assessment of the Cytotoxicity, Mutagenicity, and Genotoxicity of Two Traditional Chinese Herbs:Toxins · 2023Article
- Large population-based study of upper tract urothelial carcinoma in China may provide further insight into the impact of bladder cancer on upper tract urothelial carcinoma's prognosis in Chinese population.Translational andrology and urology · 2022Article
- Beyond Ingestion: Nasal Inhalation-Induced Aristolochic Acid Nephropathy from a Traditional Herbal Remedy - A Case Report.Glomerular diseasesArticle
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe risk of primary aristolochic acid (AA)-associated urothelial carcinoma (AA-UC) has been summarized by a 2013-published meta-analysis. Given that additional evidence has been continuously reported by original studies, an updated meta-analysis is needed. Meanwhile, to complete the whole picture, a systematic review of molecular alterations observed in AA-urinary tract cancers (AA-UTC) was also performed.
methodsWe searched PubMed, Embase and four Chinese databases up to October 2020. Observational studies comparing risk or oncologic outcomes of UTC between patients with and without AA exposure were eligible for systematic review and meta-analysis. Studies investigating molecular alterations in AA-UTC using human tissue samples were eligible for systematic review.
resultsIn total, 38 and 20 studies were included in the systematic review and meta-analysis, respectively. Exposure to AA led to an overall increased risks of primary UTC [UC and renal cell carcinoma (RCC)] (OR 6.085, 95% CI 3.045-12.160) and postoperatively recurrent UC (RR 1.831, 95% CI 1.528-2.194). Subgroup analysis of postoperative primary AA-upper tract UC (AA-UTUC) showed increased risks of bladder recurrence (adjusted RR 1.949, 95% CI 1.462-2.597) and contralateral UTUC recurrence (crude RR 3.760, 95% CI 2.225-6.353), worse overall survival (adjusted HR 2.025, 95% CI 1.432-2.865) and worse disease-specific survival (adjusted HR 3.061, 95% CI 1.190-7.872), but no effect on cancer-specific survival (adjusted HR 0.772, 95% CI 0.269-2.215). High mutation load with AA mutational signature presenting largely in the putative driver genes was observed in AA-UTUC. In contrast, AA mutational signature is rarely found in the mutated RCC driver genes and the mutation load in AA-RCC is low. Therefore, AA has different roles in the genesis of UTUC and RCC.
conclusionsImplementing effective strategies to completely protect people from exposure to AA is urgently needed. Additionally, more effort should be made in identifying the precise carcinogenic mechanisms of AA to determine the future treatment strategies. PLAIN LANGUAGE SUMMARY:
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