ID | 61761 |
フルテキストURL | |
著者 |
Laukhtina, Ekaterina
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Abufaraj, Mohammad
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Al-Ani, Abdallah
Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan
Ali, Mustafa Rami
Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan
Mori, Keiichiro
Department of Urology, The Jikei University School of Medicine
Moschini, Marco
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Quhal, Fahad
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Sari Motlagh, Reza
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Pradere, Benjamin
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Schuettfort, Victor M.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Mostafaei, Hadi
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Katayama, Satoshi
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Grossmann, Nico C.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Fajkovic, Harun
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
Soria, Francesco
Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino
Enikeev, Dmitry
Institute for Urology and Reproductive Health, Sechenov University
Shariat, Shahrokh F.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
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抄録 | Context
Patients with intermediate-risk non–muscle-invasive bladder cancer (NMIBC) may pose a clinical dilemma without an agreed evidence-based decision tree for personalized treatment. Objective To perform a systematic review and network meta-analysis (NMA) to summarize available evidence on the oncologic outcomes of intravesical therapy in patients with intermediate-risk NMIBC. Evidence acquisition The MEDLINE, EMBASE, and ClinicalTrials.gov databases were searched in October 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Studies were deemed eligible if they reported on oncologic outcomes in patients with intermediate-risk NMIBC treated with transurethral resection of bladder tumor with and without intravesical chemotherapy or bacillus Calmette-Guérin (BCG) immunotherapy. Evidence synthesis Twelve studies were included in a qualitative synthesis (systematic review); three were deemed eligible for a quantitative synthesis (NMA). An NMA of five different regimens was conducted for the association of treatment with the 5-yr recurrence risk. Chemotherapy with maintenance was associated with a lower likelihood of 5-yr recurrence than chemotherapy without maintenance (odds ratio [OR] 0.51, 95% credible interval [CI] 0.26–1.03). Immunotherapy, regardless of whether a full- or reduced-dose regimen, was not associated with a significantly lower likelihood of 5-yr recurrence when compared with chemotherapy without maintenance (OR 0.90, 95% CI 0.39–2.11 vs OR 0.93, 95% CI 0.40–2.19). Analysis of the treatment ranking revealed that chemotherapy with maintenance had the lowest 5-yr recurrence risk (P score 0.9666). Conclusions Our analysis indicates that chemotherapy with a maintenance regimen confers a superior oncologic benefit in terms of 5-yr recurrence risk compared to chemotherapy without maintenance in patients with intermediate-risk NMIBC. Regardless of the dose regimen, immunotherapy with BCG does not appear to be superior to chemotherapy in patients with intermediate-risk NMIBC in term of disease recurrence. However, owing to the lack of comparative studies, there is an unmet need for well-designed, large-scale trials to validate our findings and generate robust evidence on disease recurrence and progression. Patient summary A maintenance schedule of chemotherapy reduces the rate of long-term recurrence of bladder cancer that has not invaded the bladder muscle. Chemotherapy inserted directly into the bladder and immunotherapy without maintenance schedules seem to have limited benefit in preventing cancer recurrence. |
キーワード | Non–muscle-invasive bladder cancer
Bladder cancer
Intermediate risk
Intravesical therapy
Network meta-analysis
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発行日 | 2021-03-21
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出版物タイトル |
European Urology Focus
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出版者 | Elsevier
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ISSN | 24054569
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資料タイプ |
学術雑誌論文
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言語 |
英語
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OAI-PMH Set |
岡山大学
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著作権者 | © 2021 The Authors.
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論文のバージョン | publisher
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PubMed ID | |
NAID | |
DOI | |
関連URL | isVersionOf https://doi.org/10.1016/j.euf.2021.03.016
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ライセンス | http://creativecommons.org/licenses/by/4.0/
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Citation | Laukhtina E, Abufaraj M, Al-Ani A, Ali MR, Mori K, Moschini M, Quhal F, Sari Motlagh R, Pradere B, Schuettfort VM, Mostafaei H, Katayama S, Grossmann NC, Fajkovic H, Soria F, Enikeev D, Shariat SF; European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial carcinoma working group. Intravesical Therapy in Patients with Intermediate-risk Non-muscle-invasive Bladder Cancer: A Systematic Review and Network Meta-analysis of Disease Recurrence. Eur Urol Focus. 2021 Mar 21:S2405-4569(21)00095-X. doi: 10.1016/j.euf.2021.03.016. Epub ahead of print. PMID: 33762203.
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オープンアクセス(出版社) |
OA
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オープンアーカイブ(出版社) |
非OpenArchive
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