Context
Bladder cancer therapy remains suboptimal as the morbidity and
mortality remains high amongst those with non-muscle invasive and
muscle-invasive disease. Regional hyperthermia therapy (RHT) is a promising
adjunctive therapy being tested in multiple clinical contexts.
Objective
To systematically review the literature on the efficacy and toxicity
of RHT.
Evidence Acquisition
The systematic review was registered with the PROSPERO database
(Registration number: CRD42015025780) and was conducted according to the
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)
guidelines. We queried PubMed, EMBASE, and Cochrane libraries. Two reviewers
reviewed abstracts independently and a third reviewer arbitrated
disagreements. The last search was performed on August 28, 2015. A
descriptive analysis was performed and quality assessment was conducted
using the Newcastle-Ottawa Quality Assessment Scale for observational
studies, and the Cochrane Risk of Bias Assessment Tool for trials.
Evidence Synthesis
We identified 859 publications in the initial search, of which 24 met
inclusion criteria for full-text review. Of these, we were able to obtain
data on the outcomes of interest for 15 publications.
Conclusions
The review underscores the limited nature of the evidence; definitive
conclusions are elusive. However, the promising results of RHT in the
setting of intravesical chemotherapy, chemotherapy and radiotherapy show a
trend towards legitimate efficacy.
BackgroundSpectrum effects refer to the phenomenon that test performance varies across subgroups of a population. When spectrum effects occur during diagnostic testing for cancer, difficult patient misdiagnoses can occur. Our objective was to evaluate the effect of test indication, age, gender, race, and smoking status on the performance characteristics of two commonly used diagnostic tests for bladder cancer, urine cytology and fluorescence in situ hybridization (FISH).MethodsWe assessed all subjects who underwent cystoscopy, cytology, and FISH at our institution from 2003 to 2012. The standard diagnostic test performance metrics were calculated using marginal models to account for clustered/repeated measures within subjects. We calculated test performance for the overall cohort by test indication as well as by key patient variables: age, gender, race, and smoking status.ResultsA total of 4023 cystoscopy-cytology pairs and 1696 FISH-cystoscopy pairs were included in the analysis. In both FISH and cytology, increasing age, male gender, and history of smoking were associated with increased sensitivity and decreased specificity. FISH performance was most impacted by age, with an increase in sensitivity from 17 % at age 40 to 49 % at age 80. The same was true of cytology, with an increase in sensitivity from 50 % at age 40 to 67 % at age 80. Sensitivity of FISH was higher for a previous diagnosis of bladder cancer (46 %) than for hematuria (26 %). Test indication had no impact on the performance of cytology and race had no significant impact on the performance of either test.ConclusionsThe diagnostic performance of urine cytology and FISH vary significantly according to the patient demographic in which they were tested. Hence, the reporting of spectrum effects in diagnostic tests should become part of standard practice. Patient-related factors must contextualize the clinicians’ interpretation of test results and their decision-making.
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