首页膀胱肿瘤治疗及预后证据详情

吉西他滨较丝裂霉素治疗 TURBT 后非肌层浸润性膀胱癌的复发率低、毒副作用小 : 基于随机对照试验的荟萃分析

原文: 2021 年 发布于 PeerJ 60 卷 第 5 期 280-289 浏览量:397次 原文链接

作者: 彭磊 蒙春杨 李金泽 李云祥 李进铭 赵攀 韦堂墙 伍季

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.1590/S1677-5538.IBJU.2015.0446

关键词: Adult Aged Aged 80 and over Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use B7-H1 Antigen/antagonists & inhibitors Carcinoma/*drug therapy/immunology/mortality/pathology Clinical Decision-Making Female Humans Immune Checkpoint Inhibitors/adverse effects/*therapeutic use Male Middle Aged Patient Selection Progression-Free Survival Time Factors Urinary Bladder Neoplasms/*drug therapy/immunology/mortality/pathology Urothelium/*drug effects/immunology/pathology Immune-checkpoint inhibitor Meta-analysis Programmed death-ligand 1 Urothelial carcinoma interests/personal relationships which may be considered as potential competing interests: The authors certify that all conflicts of interest including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the article are listed as follows: Shahrokh Shariat owns or co-owns the following patents: methods to determine prognosis after therapy for prostate cancer. Granted 2002-09-06. Methods to determine prognosis after therapy for bladder cancer. Granted 2003-06-19. Prognostic methods for patients with prostatic disease. Granted 2004-08-05. Soluble Fas: urinary marker for the detection of bladder transitional cell carcinoma. Granted 2010-07-20. He has a consulting or advisory role for the following: Astellas Astra Zeneca Bayer BMS Cepheid Ferring Ipsen Jansen Lilly MSD Olympus Pfizer Pierre Fabre Roche Sanochemia Sanofi Takeda Urogen and Wolff. All remaining authors have declared no conflicts of interest.

文献简介

Objective: Studies have showed that different follow-up starting points might potentially impact the comparison between primary (PMIBC) and secondary muscle-invasive bladder cancer (SMIBC), but the only previous meta-analysis did not differentiate the follow-up starting points of included studies. With more trials published, we aim to update the meta-analysis comparing PMIBC and SMIBC. Methods: PubMed, Embase, Cochrane Library and ClinicalTrial.gov . systematically searched. Literatures comparing the survival outcomes of PMIBC and SMIBC were selected. Outcomes of cancer-specific mortality (CSM), overall mortality (OM) and recurrence-free survival (RFS) were pooled and grouped based on the starting point of follow-up (after initial diagnosis or radical cystectomy (RC)). Newcastle-Ottawa Scale (NOS) and funnel plot were employed to assess the study quality and publication bias, respectively. Results: A total of 17 high-quality studies were selected, with 5558 patients aged from 59.8 to 72.7 (mean value) involved. The male-to-female ratio was roughly 4:1 (4390/1124). SMIBC had lower risk of CSM after initial diagnosis (HR 0.81, 95%Cl 0.67-0.98, P=0.03,1 2 =70%), but higher risk of CSM after RC (HR 1.45, 95%CI 1.27-1.65, P<0.00001, 1 2 =64%). In terms of OM and recurrence, outcomes were pooled only after RC, which both turned out to be higher for SMIBC (OM: HR 1.50, 95%Cl 1.30-1.73, P<0.00001, 1 2 =0%; Recurrence: HR 1.66, 95%Cl 1.36-2.02, P<0.00001, 1 2 =48%). No obvious publication bias was observed from funnel plot. Conclusion: The current study suggested SMIBC had higher risk of CSM, OM and recurrence after RC, but lower risk of CSM after initial diagnosis.