Muscle-invasive bladder cancer organ-preserving therapy: systematic review and meta-analysis

García‐Perdomo, Herney Andrés; Montes-Cardona, Carlos Eduardo; Guacheta, Marcela; Castillo, Diego Fernando; Reis, Leonardo Oliveira

doi:10.1007/s00345-018-2384-6

Cited by 32 publications

(25 citation statements)

References 37 publications

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“…Fahmy et al ( 13 ) indicated that the OS and disease-specific survival (DSS) were comparable between TMT and RC: the average 10-year OS rate was 30.9% for TMT and 35.1% for RC, respectively ( P = 0.32), and the average 10-year DSS rate was 50.9% for TMT and 57.8% for RC, respectively ( P = 0.26). García-Perdomo et al ( 15 ) reported that CSS rate favored patients who underwent RC. However, most included studies were case series in the systematic reviews by Arcangeli et al ( 14 ) and Fahmy et al ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, several clinical trials compared the outcomes between RC and TMT ( 10 – 12 ). Most of the literature included in the previous meta-analysis were case series ( 9 , 13 , 14 ) and did not directly compare the efficacy of RC and TMT; and not all included patients were performed standard TMT in the other meta-analysis ( 15 ). So, it is essential to perform a meta-analysis directly comparing RC and standard TMT.…”

Section: Introductionmentioning

confidence: 99%

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Trimodal Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Meta-Analysis

et al. 2020

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Background: To compare the difference between trimodal therapy (TMT) and radical cystectomy (RC) in treating muscle-invasive bladder cancer, we performed a meta-analysis for data from the following database. Methods: We searched PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wanfang databases, and Google Scholar up to December 2019. The main outcome measures assessed were overall survival (OS), cancer-specific survival (CSS), mortality, and Charlson comorbidity score (CCS). Two authors independently evaluated the study quality and extracted data. All data were analyzed using Review Manager (version 5.3). Results: After database retrieval, article selection, data extraction, and quality assessment, nine articles comprising 5,721 cases from the TMT group and 48,262 cases from the RC group were included in this study. The data showed that there was no statistical difference between TMT and RC at <10 years OS [pooled hazard ratio (HR) = 1.26, 95% confidence interval (CI): 0.92–1.73, Z = 1.46, P = 0.14], while OS of the RC group was higher than that of the TMT group at more than 10 years (pooled HR = 1.34, 95% CI: 1.18–1.54, Z = 4.33, P < 0.0001). As for CSS, compared with the TMT group, the patients in the RC group had longer CSS (pooled HR = 1.50, 95% CI: 1.29–1.76, Z = 5.15, P < 0.00001). Compared with RC, TMT is linked to an obvious increase in all-cause mortality and bladder-specific cancer mortality (pooled HR = 1.30, 95% CI: 1.16–1.46, Z = 4.55, P < 0.00001; pooled HR = 1.32, 95% CI: 1.15–1.51, Z = 3.92, P < 0.0001). The bladder cancer patients belonging to CCS “0” score preferred RC [pooled relative risk (OR) = 0.94, 95% CI: 0.89–0.98, Z = 2.79, P = 0.005], while CCS “2” score's patients were prone to TMT (pooled OR = 1.40, 95% CI: 1.29–1.53, Z = 7.73, P < 0.00001). Conclusions: Overall, this meta-analysis suggests that the efficacy of TMT is non-inferior to that of RC at <10-year OS, and RC is superior to TMT at more than 10-year OS. Therefore, TMT may be a reasonable treatment option in well-selected patients who are unsuitable for surgery or are not willing to experience surgery. In the future, more high-quality, large-sample randomized controlled trials (RCTs) are needed to verify the results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trimodal Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Meta-Analysis

et al. 2020

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“…In a 2015 review by Arcangeli et al [8], CMT was not associated with a statistically significant survival advantage (5‐year OS: 57% vs 52%, P = 0.4). Similarly, in a 2018 systematic review by Garcia‐Perdomo et al [7] no difference in OS was found between CMT or RC (hazard ratio [HR] 1.06, 95% CI 0.85–1.31); however, DSS was better in the RC arm (HR 1.23; 95% CI 1.04–1.46).…”

Section: Introductionmentioning

confidence: 90%

“…Other reviews have been conducted analysing RC vs CMT without the use of BT [7,8]. In a 2015 review by Arcangeli et al [8], CMT was not associated with a statistically significant survival advantage (5‐year OS: 57% vs 52%, P = 0.4).…”

Section: Introductionmentioning

confidence: 99%

Overall survival, disease‐specific survival and local recurrence outcomes in patients with muscle‐invasive bladder cancer treated with external beam radiotherapy and brachytherapy: a systematic review

et al. 2020

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Registration: PROSPERO registration number is: CRD42019129349. ConclusionBrachytherapy as part of CMT for MIBC is not a standard technique. It is an effective treatment in experienced centres for a selected patient population who wish to preserve their bladder. In such patients, CMT-BT is well tolerated with an acceptable safety profile.Keywords muscle-invasive bladder cancer, interstitial brachytherapy, external beam radiotherapy, organ preservation

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“…Radical cystectomy (RC) with cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for the management of muscleinvasive BCa (MIBC). In recent years, bladder-preserving strategies combining bladder tumor transurethral resection (TURB) with radiotherapy and concurrent radio-sensitizing chemotherapy, also known as trimodal therapy (TMT), have shown similar results and reduced morbidity as compared to RC in selected MIBC patients (2,3). As a result, current guidelines now recommend both RC and TMT as effective treatment options for MIBC (4)(5)(6)(7).…”

mentioning

confidence: 99%

How to guide the selection of patients for trimodality therapy: the case for tumor immune and stromal signature

Boeri

Karnes

Montanari

2019

Transl. Androl. Urol

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Muscle-invasive bladder cancer organ-preserving therapy: systematic review and meta-analysis

Abstract: We found no differences in overall survival and progression-free survival between these two interventions. Nonetheless, we found that cancer-specific survival favored patients who received radical cystectomy.

Cited by 32 publications

References 37 publications

Trimodal Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Meta-Analysis

Trimodal Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Meta-Analysis

Overall survival, disease‐specific survival and local recurrence outcomes in patients with muscle‐invasive bladder cancer treated with external beam radiotherapy and brachytherapy: a systematic review

How to guide the selection of patients for trimodality therapy: the case for tumor immune and stromal signature

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