首页膀胱肿瘤治疗及预后证据详情

Standard Transurethral Resection versus Laser Surgery for Bladder Cancer: A Systematic Review and Meta-Analysis

原文: 2022 年 发布于 Eur J Clin Invest 61 卷 第 10 期 8493519 浏览量:163次

作者: Sullivan N. O. MacCraith E. Temperley H. Naughton A. Forde J. Davis N.

作者单位: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. Department of Urology, Inha University College of Medicine, Incheon, Korea. Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.3389/fsurg.2022.849929

关键词: Humans *Urinary Bladder Neoplasms/surgery/pathology Neoplasm Recurrence Local/pathology Cystectomy/methods Cystoscopy/methods Light #BladderCancer #blcsm #uroonc blue light non-muscle-invasive bladder cancer photodynamic diagnosis transurethral resection of the bladder white light

文献简介

PURPOSE: Urothelial carcinoma has a higher incidence in renal transplanted patients according to several registries (relative risk × 3), and the global prognosis is inferior to the general population. The potential impact of immunosuppressive therapy on the feasibility, efficacy, and complications of endovesical treatment, especially Bacillus Calmette-Guerin, has a low level of evidence. We performed a systematic review that aimed to assess the morbidity and oncological outcomes of adjuvant endovesical treatment in solid organ transplanted patients. METHODS: Medline was searched up to December 2021 for all relevant publications reporting oncologic outcomes of endovesical treatment in solid organ transplanted patients with NMIBC. Data were synthesized in light of methodological and clinical heterogeneity. RESULTS: Twenty-three retrospective studies enrolling 238 patients were included: 206 (96%) kidney transplants, 5 (2%) liver transplants, and 2 (1%) heart transplants. Concerning staging: 25% were pTa, 62% were pT1, and 22% were CIS. 140/238 (59%) patients did not receive adjuvant treatment, 50/238 (21%) received mitomycin C, 4/238 (2%) received epirubicin, and 46/238 (19%) received BCG. Disease-free survival reached 35% with TURBT only vs. 47% with endovesical treatment (Chi-square test p = 0.08 OR 1.2 [0.98-1.53]). The complication rate of endovesical treatment was 12% and was all minor (Clavien-Dindo I). CONCLUSION: In solid organ transplanted patients under immunosuppressive treatment, both endovesical chemotherapy and BCG are safe, but the level of evidence concerning efficacy in comparison with the general population is low. According to these results, adjuvant treatment should be proposed for NMIC in transplanted patients as in the general population.

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