Bipolar versus monopolar transurethral resection of non-muscle-invasive bladder cancer: a systematic review and meta-analysis of randomized controlled trials
原文： 2021 年 发布于
J Pers Med
31 卷 第 6 期 E299-E300
浏览量：194次
作者：
Xie K.
Cao D.
Wei Q.
Ren Z.
Li J.
Li Y.
Fu M.
作者单位：
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: paolo.delloglio@gmail.com. Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. University of Southern California Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Department of Urology, University of Verona, Verona, Italy. Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. Department of Urology, Institut Mutualiste Montsouris, Paris, France. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 1st Department of Urology, University of Athens Medical School, Athens, Greece. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
ORSI Academy, Melle, Belgium. University of Southern California Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: giovanni.cacciamani@med.usc.edu.
归属分类：
膀胱肿瘤治疗及预后证据
DOI：
10.1016/j.niox.2021.06.003
关键词：
Carcinoma
Transitional Cell/*classification/*genetics/mortality
Humans
Predictive Value of Tests
Survival Rate
Treatment Outcome
Urinary Bladder Neoplasms/*classification/*genetics/mortality
Bladder cancer
Molecular classification
Molecular subtype
Prognosis
Progression
Urothelial carcinoma
BACKGROUND: Neoadjuvant chemotherapy is the standard of care before radical cystectomy for muscle invasive bladder cancer. Recently, checkpoint inhibitors have been investigated as a neoadjuvant treatment after the reported efficacy of checkpoint inhibitors in metastatic urothelial carcinoma. OBJECTIVES: The aim of this systematic review is to investigate the role of checkpoint inhibitors as a neoadjuvant treatment for muscle invasive bladder cancer before radical cystectomy. METHODS: Based on the PRISMA statement, a systematic review of the literature was conducted through online databases and the American Society of Clinical Oncology (ASCO) Meeting Library. Suitable publications were subjected to full-text assessment. The primary outcome of this review was to identify the impact of neoadjuvant immunotherapy on the oncological outcomes and survival benefits. RESULTS: From the retrieved 254 results, 8 studies including 404 patients were included. Complete response varied between 30% and 50%. Downstaging varied between 50% and 74%. ≥Grade 3 AEs were recorded in 8.6% of patients who received monotherapy with either Atezolizumab or Pembrolizumab. In patients who received combination treatment, the incidence of ≥Grade 3 AEs was 16.3% for chemoimmunotherapy and 36.5% for combined immunotherapy. A total of 373 patients (92%) underwent radical cystectomy. ≥Grade 3 Clavien-Dindo surgical complications were reported in 21.7% of the patients. One-year overall survival (OS) and relapse-free survival (RFS) varied between 81% and 92%, and 70% and 88%, respectively. CONCLUSION: The evidence on the use of immune checkpoint inhibitors in the setting of pre-radical cystectomy is quite limited, with noted variability within published trials. Combination with chemotherapy or another checkpoint inhibitor may boost response, although prospective studies with extended follow-up are needed to report on the survival advantages.