Investig Clin Urol.  2019 Mar;60(2):64-74. 10.4111/icu.2019.60.2.64.

Role of adjuvant cisplatin-based chemotherapy following radical cystectomy in locally advanced muscle-invasive bladder cancer: Systematic review and meta-analysis of randomized trials

Affiliations
  • 1Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. kscho99@yuhs.ac
  • 2Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Urology, Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

Abstract

PURPOSE
We purposed to assess the effects of adjuvant chemotherapy (ACH) on survival outcomes in patients with locally advanced muscle-invasive bladder cancer (MIBC) who are treated with radical cystectomy (RC).
MATERIALS AND METHODS
Literature search was conducted in PubMed, Embase, and Cochrane library databases for all articles that were published until February 2018. Systematic review and meta-analysis were performed by pooling the randomized controlled trials (RCTs) that compared patients with locally advanced MIBC who received ACH after RC to those who underwent cystectomy alone. Endpoints were progression free survival (PFS) and overall survival (OS).
RESULTS
Four RCTs with a total of 490 patients were selected for the analysis. These four trials included patients with locally advanced MIBC. Pooled HRs for PFS and OS across the studies were 0.48 (95% confidence interval [CI], 0.39-0.60; p < 0.00001) and 0.63 (95% CI, 0.48-0.83; p=0.0009), respectively. Absolute increases in PFS and OS for locally advanced MIBC were 17% and 10%, respectively (i.e., equivalent to numbers needed to treat of 5.9 and 10).
CONCLUSIONS
ACH following RC may improve the survival outcomes of locally advanced MIBC patients. Beneficial effect of ACH might be more marked in patients with locally advanced MIBC when comparing the previously reported meta-analysis with all MIBC patients.

Keyword

Drug therapy; Meta-analysis; Randomized controlled trial; Systematic review; Urinary bladder neoplasms

MeSH Terms

Chemotherapy, Adjuvant
Cystectomy*
Disease-Free Survival
Drug Therapy*
Humans
Numbers Needed To Treat
Urinary Bladder Neoplasms*
Urinary Bladder*

Figure

  • Fig. 1 Preferred reporting items for systematic reviews and meta-analysis flowchart. RCT, randomized controlled trial; MIBC, muscle-invasive bladder cancer.

  • Fig. 2 (A) Forest plots of PFS in locally advanced MIBC (pT3-4 and/or pN+ and M0), (B) forest plots of OS in locally advanced MIBC (pT3-4 and/or pN+ and M0). PFS, progression-free survival; MIBC, muscle-invasive bladder cancer; OS, overall survival; SE, standard error; CI, confidence interval; df, degrees of freedom; ACH, adjuvant chemotherapy.

  • Fig. 3 Funnel plots for publication bias. (A) Progression-free survival. (B) Overall survival.

  • Fig. 4 Risk of bias assessment. Green plus indicates low risk of bias; yellow question mark indicates unclear risk of bias; red minus indicates high risk of bias.

  • Fig. 5 Risk of bias graph.


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