首页膀胱肿瘤治疗及预后证据详情

Reduced- vs full-dose BCG in bladder cancer: A systematic review and meta-analysis

原文: 2023 年 发布于 Actas Urol Esp (Engl Ed) 95 卷 第 6 期 2673-2691 浏览量:258次

作者: Verri P. Baboudjian M. Diana P. Gallioli A. Territo A. Gaya J. M. Huguet J. Rodriguez-Faba O. Palou J. Breda A.

作者单位: Department of Urology, University of Michigan, Ann Arbor, Michigan, USA. College of Medicine, California Northstate University, Elk Grove, California, USA. Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA. Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA. Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany. Department of Urology, University of Ulm, Ulm, Germany.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.1111/eci.13822

关键词: Humans Smoking/adverse effects/epidemiology *Non-Muscle Invasive Bladder Neoplasms *Urinary Bladder Neoplasms/epidemiology/etiology *Carcinoma Transitional Cell Prognosis Neoplasm Recurrence Local/epidemiology Current smoker Non-muscle-invasive bladder cancer Progression Recurrence Smoking

文献简介

OBJECTIVE: To assess the oncologic outcomes and the safety profile of a reduced-dose versus full-dose BCG regimen in patients with non-muscle-invasive bladder cancer (NMIBC). MATERIAL AND METHODS: We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed, Embase, and Web of Science databases were searched in January 2022 for studies that analyzed oncological outcomes and compared between reduced- and full-dose BCG regimens. RESULTS: Seventeen studies including 3757 patients met our inclusion criteria. Patients who received reduced-dose BCG had significantly higher recurrence rates (OR 1.19; 95%CI, 1.03-1.36; p = 0.02). The risks of progression to muscle-invasive BC (OR 1.04; 95%CI, 0.83-1.32; p = 0.71), metastasis (OR 0.82; 95%CI, 0.55-1.22; p = 0.32), death from BC (OR 0.80; 95%CI, 0.57-1.14; p = 0.22), and all-cause death (OR 0.82; 95%CI, 0.53-1.27; p = 0.37) were not statistically different. When restricting the analyses to randomized controlled trials, we found similar results. In subgroup analysis, reduced dose was associated with a higher rate of BC recurrence in studies that used only an induction regimen (OR 1.70; 95%CI, 1.19-2.42; p = 0.004), but not when a maintenance regimen was used (OR 1.07; 95%CI, 0.96-1.29; p = 0.17). Regarding side effects, the reduced-dose BCG regimen was associated with fewer episodes of fever (p = 0.003), and therapy discontinuation (p = 0.03). CONCLUSION: This review found no association between BCG dose and BC progression, metastasis, and mortality. There was an association between reduced dose and BC recurrence, which was no longer significant when a maintenance regimen was used. In times of BCG shortage, reduced-dose regimens could be offered to BC patients.

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