经尿道膀胱肿瘤激光切除术与传统电切手术治疗非肌层浸润性膀胱癌的疗效与安全性的比较：系统回顾与荟萃分析

原文： 2021 年发布于 Front Oncol 15 卷第 16 期 Cd013776  浏览量：212次 原文链接

作者单位： Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.

归属分类：膀胱肿瘤治疗及预后证据

DOI： 10.1080/2090598x.2020.1859055

关键词： *Cystectomy/adverse effects Humans Morbidity Postoperative Complications/epidemiology Retrospective Studies *Urinary Bladder Neoplasms/surgery bladder disorders surgery urological tumours

BACKGROUND: To summarize the current evidence on the effects of intra-arterial chemotherapy (IAC) on high-risk non-muscle invasive bladder cancer (NMIBC) and compare oncology results with intravesical chemotherapy (IVC). METHODS: We performed a systematic review and cumulative meta-analysis of the primary outcomes of interest by a systematical search of multiple scientific databases in February 2021. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous variables respectively, with 95% confidence intervals (CIs). The hazard radio (HR) with 95% CIs was used for overall survival (OS), recurrence-free survival (RFS) and progression-free survival (PFS). RESULTS: A total of six studies with 866 patients were included. For IAC combined with IVC versus IVC alone, statistically significant differences were found regarding tumor recurrence rate (OR: 0.51, 95% CI [0.36 ∼ 0.72], p = 0.0001), tumor progression rate (OR: 0.47, 95% CI [0.30 ∼ 0.72], p = 0.0006), tumor-specific death rate (OR: 0.49, 95% CI [0.25 ∼ 0.99], p = 0.05), PFS (HR: 0.47, 95% CI [0.23 ∼ 0.96], p = 0.04) and RFS (HR: 0.60, 95% CI [0.41 ∼ 0.87], p = 0.007). No significant difference between two groups was found for time to first recurrence (MD: 3.27, 95% CI [-2.37 ∼ 8.92], p = 0.26) and OS (HR: 1.20, 95% CI [0.44 ∼ 3.32], p = 0.72). For IAC alone versus IVC, There was no statistical difference in the terms of tumor-specific death rate (OR: 0.67, 95% CI [0.29 ∼ 1.53], p = 0.34), RFS (HR: 0.90, 95% CI [0.56 ∼ 1.46], p = 0.68) and PFS (HR: 0.71, 95% CI [0.32 ∼ 1.55], p = 0.39). Adverse events mainly included nausea/vomiting (36.3%), hypoleukemia (19.4%), neutropenia (16.0%), increased creatinine (9.9%), increased alanine aminotransferase (18.7%), and thrombocytopenia (9.9%). CONCLUSION: The IAC combined with IVC is a safe and effective treatment for high risk NMIBC, with lower rates of recurrence, progression, tumor-specific death, PFS and RFS, and with minor and tolerable events. The effectiveness of the IAC alone is parallel to the IVC alone.