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Comparison between different neoadjuvant chemotherapy regimens and local therapy alone for bladder cancer: a systematic review and network meta-analysis of oncologic outcomes
A. Aydh, R. Sari Motlagh, A. Alamri, T. Yanagisawa, A. Ayed, P. Rajwa, E. Laukhtina, SM. Alasiri, T. Kawada, H. Mostafai, A. Ayidh, M. Pallauf, F. König, M. Abufaraj, PI. Karakiewicz, SF. Shariat
Language English Country Germany
Document type Meta-Analysis, Systematic Review, Journal Article
- MeSH
- Bayes Theorem MeSH
- Cisplatin * therapeutic use MeSH
- Cystectomy MeSH
- Doxorubicin therapeutic use MeSH
- Gemcitabine MeSH
- Humans MeSH
- Methotrexate therapeutic use MeSH
- Urinary Bladder Neoplasms * drug therapy MeSH
- Neoadjuvant Therapy methods MeSH
- Antineoplastic Combined Chemotherapy Protocols MeSH
- Network Meta-Analysis as Topic MeSH
- Vinblastine therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
PURPOSE: The present systematic review and network meta-analysis (NMA) compared the current different neoadjuvant chemotherapy (NAC) regimes for bladder cancer patients to rank them. METHODS: We used the Bayesian approach in NMA of six different therapy regimens cisplatin, cisplatin/doxorubicin, (gemcitabine/cisplatin) GC, cisplatin/methotrexate, methotrexate, cisplatin, and vinblastine (MCV) and (MVAC) compared to locoregional treatment. RESULTS: Fifteen studies comprised 4276 patients who met the eligibility criteria. Six different regimes were not significantly associated with a lower likelihood of overall mortality rate compared to local treatment alone. In progression-free survival (PFS) rates, cisplatin, GC, cisplatin/methotrexate, MCV and MVAC were not significantly associated with a higher likelihood of PFS rate compared to locoregional treatment alone. In local control outcome, MCV, MVAC, GC and cisplatin/methotrexate were not significantly associated with a higher likelihood of local control rate versus locoregional treatment alone. Nevertheless, based on the analyses of the treatment ranking according to SUCRA, it was highly likely that MVAC with high certainty of results appeared as the most effective approach in terms of mortality, PFS and local control rates. GC and cisplatin/doxorubicin with low certainty of results was found to be the best second options. CONCLUSION: No significant differences were observed in mortality, progression-free survival and local control rates before and after adjusting the type of definitive treatment in any of the six study arms. However, MVAC was found to be the most effective regimen with high certainty, while cisplatin alone and cisplatin/methotrexate should not be recommended as a neoadjuvant chemotherapy regime.
Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Canada
Department of Family Medicine King Khalid University Abha Saudi Arabia
Department of Radiology King Khalid University Abha Saudi Arabia
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Aseer Central Hospital Abha Saudi Arabia
Department of Urology King Faisal Medical City Abha Saudi Arabia
Department of Urology Medical University of Silesia Zabrze Poland
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Division of Urology Department of Surgery King Khalid University Abha Saudi Arabia
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
The National Center for Diabetes Endocrinology and Genetics The University of Jordan Amman Jordan
References provided by Crossref.org
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- $a Aydh, Abdulmajeed $u Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria $u Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
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