The Efficacy and Safety of Hyperthermic Intravesical Chemotherapy Compared with Other Instillation Methods in Treating Intermediate- and High-Risk Non-Muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Yingying Yang, Hongquan Liu, Yongli Chu, Jipeng Wang, Jian Ma, Guixin Ding, Xingjun Bao, Yuanshan Cui, Jitao Wu
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Abstract

Background. In order to prevent the recurrence and progression of intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT), various bladder instillation therapies have been developed in recent years. Among these, device-assisted Hyperthermic Intravesical Chemotherapy (HIVEC) has received a great deal of attention. Objective. To identify the efficacy and safety of HIVEC, we conducted this meta-analysis. Methods. We identified relevant articles from PubMed, Embase, and Cochrane Library databases. All published randomized controlled trials (RCTs) describing the role of bladder instillation for the treatment of intermediate- and high-risk NMIBC were involved. Outcomes included 1–3 years Recurrence-Free Survival (RFS), 1–3 years Progression-Free Survival (PFS), 5 years Overall Survival (OS), Adverse Events (AEs), and relevant subgroup analyses. Result. Our study involved a total of 10 RCTs and 1360 patients. In subgroup analysis, we found that compared to MMC instillation, HIVEC decreased the 1–3 years RFS (OR = 0.51; p = 0.009) while not increasing the incidence of AEs (OR = 0.86; p = 0.30). Compared with BCG instillation, HIVEC reduced the incidence of serious AEs (OR = 0.21; p = 0.04) while bringing the same efficacy (OR = 0.78; p = 0.63). Conclusion. HIVEC combined the advantages of efficacy and safety compared with the two recommended instillation modalities. As a potential alternative therapy, its widespread clinical effect remains to be further evaluated.

高热膀胱内化疗与其他灌注方法治疗中、高危非肌浸润性膀胱癌的有效性和安全性比较:系统回顾与元分析
背景。为了预防经尿道膀胱肿瘤切除术(TURBT)后中高危非肌浸润性膀胱癌(NMIBC)的复发和进展,近年来已开发出多种膀胱灌注疗法。其中,设备辅助热疗膀胱内化疗(Hyperthermic Intravesical Chemotherapy,HIVEC)受到了广泛关注。目的为了确定 HIVEC 的有效性和安全性,我们进行了这项荟萃分析。方法我们从 PubMed、Embase 和 Cochrane Library 数据库中查找了相关文章。所有已发表的描述膀胱灌注治疗中高危 NMIBC 作用的随机对照试验(RCT)均被纳入其中。结果包括 1-3 年无复发生存期(RFS)、1-3 年无进展生存期(PFS)、5 年总生存期(OS)、不良事件(AEs)以及相关亚组分析。研究结果我们的研究共涉及 10 项 RCT 和 1360 名患者。在亚组分析中,我们发现与 MMC 灌注相比,HIVEC 降低了 1-3 年的 RFS(OR = 0.51;),同时没有增加 AE 的发生率(OR = 0.86;)。与卡介苗灌注相比,HIVEC 降低了严重 AEs 的发生率(OR = 0.21;),同时带来了相同的疗效(OR = 0.78;)。结论与推荐的两种灌注方式相比,HIVEC兼具疗效和安全性的优点。作为一种潜在的替代疗法,其广泛的临床效果仍有待进一步评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
0.00%
发文量
274
审稿时长
3-8 weeks
期刊介绍: IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.
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