首页膀胱肿瘤治疗及预后证据详情

前列腺癌放射治疗与继发性膀胱癌相关性的荟萃分析

原文: 2018 年 发布于 Int J Environ Res Public Health 18 卷 第 9 期 e6097 浏览量:161次

作者: 张朝枫

作者单位: Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Canada. Electronic address: Vickie.kong@rmp.uhn.on.ca. Sheffield Hallam University, Sheffield, UK. Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Canada.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.1016/j.eururo.2018.11.052

关键词: androgen receptor bladder cancer meta-analysis prognosis

文献简介

CONTEXT: The incidence of urothelial carcinoma of the bladder (UCB) is lower in women; however, women tend to present with more advanced disease. To date, there is no quantitative synthesis of studies reporting gender-specific outcomes in non-muscle-invasive UCB. OBJECTIVE: To conduct a meta-analysis evaluating gender-specific differences in recurrence of non-muscle-invasive urinary bladder cancer (NMIBC). EVIDENCE ACQUISITION: An unrestricted systematic literature search of the MEDLINE, EMBASE, and Cochrane libraries was conducted. Studies evaluating the impact of gender on disease recurrence after local treatment of NMIBC using multivariable Cox proportional hazard models were included. Random effect meta-analysis, subgroup analyses, meta-influence, and cumulative meta-analyses were conducted. Publication bias was assessed via a funnel plot and Eggeŕs test. EVIDENCE SYNTHESIS: Of 609 studies screened, 27 comprising 23 754 patients were included. Random effect meta-analyses indicated women at increased risk for UCB recurrence compared with men (hazard ratio [HR]=1.11, 95% confidence interval [CI]: 1.01-1.23, p=0.03). Subgroup analyses yielded estimates between HR=0.99 and HR=1.68. Gender-specific differences in UCB recurrence were most pronounced in studies administering exclusively bacillus Calmette-Guerin (BCG; HR=1.64, 95% CI: 1.13-2.39, p=0.01), especially in a long-term treatment regimen (HR=1.68, 95% CI: 1.32-2.15, p<0.001). Sensitivity analyses confirmed female patients at increased risk for UCB recurrence. CONCLUSIONS: Women are at increased risk for disease recurrence after local treatment of NMIBC compared with male patients. Reduced effectiveness of BCG treatment might underlie this observation. Gender-specific differences were evident across various subgroups and proved robust upon sensitivity analyses. PATIENT SUMMARY: In this report, we combined several studies on gender-specific differences in relapse of superficial bladder cancer. Women were more likely to experience cancer relapse than men.

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