Background: The role of the IGF axis in bladder cancer has been extensively studied in recent years, but the results are controversial. Methods: Pubmed, Embase, China national knowledge infrastructure and Wanfang databases were searched to identify eligible studies to evaluate the association among IGF-1, IGFBP-3, IGF-1R and IMP-3 expression and bladder cancer risk, depth of invasion and recurrence. Results: 15 studies were involved in the analysis, 5 of them reported the relation between serum concentration of IGF-1 or IGFBP-3 and bladder cancer risk. The difference in serum IGF-1 concentration was not significant between patients with bladder cancer and health controls (P=0.57). The serum IGFBP-3 concentration was lower in patients with bladder cancer (SMD: -0.78, 95% CI: -1.40, -0.15). 10 studies were involved in the analysis of the relation between IGF-1R or IMP-3 expression and bladder cancer. The expressions of IGF-1R and IMP-3 were elevated in MIBC compared with NMIBC (OR: 0.30, 95% CI: 0.19, 0.48 and OR: 0.30, 95% CI: 0.19, 0.46). The expressions of IGF-1R and IMP-3 were also found to be elevated in recurrent bladder cancer compared with primary bladder cancer (OR: 5.05, 95% CI: 2.43, 10.51 and OR: 2.47, 95% CI 1.48, 4.13). Conclusion: The IGF axis plays an important role in tumor proliferation and invasion, recurrence and metastasis. IGFBP-3 may be a potential serum biomarker for the screening of bladder cancer. The elevated expressions of IGF-1R and IMP3 in tissue are symbols of a highly malignant bladder cancer, and they could be utilized in the molecular classification of bladder. IGF-1R may be a promising therapeutic target for bladder cancer, but further studies are needed to evaluate the sensitivity of bladder cancer to the new targeted drugs and the predictive effect of serum IGFs in the targeted therapy.