Systematic Review and Individual Patient Data Meta-analysis of Randomized Trials Comparing a Single Immediate Instillation of Chemotherapy After Transurethral Resection with Transurethral Resection Alone in Patients with Stage pTa-pT1 Urothelial Carcinoma of the Bladder: Which Patients Benefit from the Instillation?
Jazyk angličtina Země Švýcarsko Médium print-electronic
Typ dokumentu časopisecké články, metaanalýza, práce podpořená grantem, přehledy, systematický přehled
Grantová podpora
MC_U122861330
Medical Research Council - United Kingdom
MC_UU_12023/20
Medical Research Council - United Kingdom
MC_UU_12023/25
Medical Research Council - United Kingdom
MC_UU_12023/28
Medical Research Council - United Kingdom
PubMed
26091833
DOI
10.1016/j.eururo.2015.05.050
PII: S0302-2838(15)00456-X
Knihovny.cz E-zdroje
- Klíčová slova
- Chemotherapy, Meta-analysis, Non–muscle-invasive bladder cancer, Single instillation, Systematic review,
- MeSH
- aplikace intravezikální MeSH
- časové faktory MeSH
- doxorubicin aplikace a dávkování analogy a deriváty MeSH
- epirubicin aplikace a dávkování MeSH
- karcinom z přechodných buněk mortalita patologie terapie MeSH
- lidé MeSH
- lokální recidiva nádoru prevence a kontrola MeSH
- míra přežití MeSH
- mitomycin aplikace a dávkování MeSH
- nádory močového měchýře mortalita patologie terapie MeSH
- progrese nemoci MeSH
- protokoly protinádorové kombinované chemoterapie aplikace a dávkování MeSH
- randomizované kontrolované studie jako téma MeSH
- rizikové faktory MeSH
- staging nádorů MeSH
- thiotepa aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- systematický přehled MeSH
- Názvy látek
- doxorubicin MeSH
- epirubicin MeSH
- mitomycin MeSH
- pirarubicin MeSH Prohlížeč
- thiotepa MeSH
CONTEXT: The European Association of Urology non-muscle-invasive bladder cancer (NMIBC) guidelines recommend that all low- and intermediate-risk patients receive a single immediate instillation of chemotherapy after transurethral resection of the bladder (TURB), but its use remains controversial. OBJECTIVE: To identify which NMIBC patients benefit from a single immediate instillation. EVIDENCE ACQUISITION: A systematic review and individual patient data (IPD) meta-analysis of randomized trials comparing the efficacy of a single instillation after TURB with TURB alone in NMIBC patients was carried out. EVIDENCE SYNTHESIS: A total of 13 eligible studies were identified. IPD were obtained for 11 studies randomizing 2278 eligible patients, 1161 to TURB and 1117 to a single instillation of epirubicin, mitomycin C, pirarubicin, or thiotepa. A total of 1128 recurrences, 108 progressions, and 460 deaths (59 due to bladder cancer [BCa]) occurred. A single instillation reduced the risk of recurrence by 35% (hazard ratio [HR]: 0.65; 95% confidence interval [CI], 0.58-0.74; p<0.001) and the 5-yr recurrence rate from 58.8% to 44.8%. The instillation did not reduce recurrences in patients with a prior recurrence rate of more than one recurrence per year or in patients with an European Organization for Research and Treatment of Cancer (EORTC) recurrence score ≥5. The instillation did not prolong either the time to progression or death from BCa, but it resulted in an increase in the overall risk of death (HR: 1.26; 95% CI, 1.05-1.51; p=0.015; 5-yr death rates 12.0% vs 11.2%), with the difference appearing in patients with an EORTC recurrence score ≥5. CONCLUSIONS: A single immediate instillation reduced the risk of recurrence, except in patients with a prior recurrence rate of more than one recurrence per year or an EORTC recurrence score ≥5. It does not prolong either time to progression or death from BCa. The instillation may be associated with an increase in the risk of death in patients at high risk of recurrence in whom the instillation is not effective or recommended. PATIENT SUMMARY: A single instillation of chemotherapy immediately after resection reduces the risk of recurrence in non-muscle-invasive bladder cancer; however, it should not be given to patients at high risk of recurrence due to its lack of efficacy in this subgroup.
Duke University Medical Center Division of Urology Durham NC USA
EORTC Headquarters Department of Biostatistics Brussels Belgium
Ghent University Hospital Department of Urology Ghent Belgium
Higashi Nagoya Hospital Department of Urology Nagoya Japan
Hyvinkaa Hospital Department of Urology Hyvinkaa Finland
Jeroen Bosch Hospital Department of Urology 's Hertogenbosch The Netherlands
Ospedale Sant'Andrea University La Sapienza Department of Urology Rome Italy
Royal Preston Hospital Rosemere Cancer Centre Preston UK
Skane University Hospital Department of Urology Malmo Sweden
Turkiye Yuksek Ihtisas Education and Research Hospital Department of Urology Ankara Turkey
University of Aberdeen Academic Urology Unit Aberdeen UK
University of Gothenburg Department of Urology Gothenburg Sweden
Urology and Nephrology Center Mansoura University Department of Urology Mansoura Egypt
Valencia Oncology Institute Department of Urology Valencia Spain
Citace poskytuje Crossref.org
Recurrence mechanisms of non-muscle-invasive bladder cancer - a clinical perspective
Bladder cancer therapy using a conformationally fluid tumoricidal peptide complex