Trimodality Therapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis of Matched Cohort Studies.

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2024-11-21 DOI:10.1016/j.euf.2024.11.003

Akihiro Matsukawa, Takafumi Yanagisawa, Marcin Miszczyk, Mehdi Kardoust Parizi, Tamás Fazekas, Ichiro Tsuboi, Stefano Mancon, Jakob Klemm, Robert Schulz, Anna Cadenar, Ekaterina Laukhtina, Paweł Rajwa, Keiichiro Mori, Jun Miki, Takahiro Kimura, Shahrokh F Shariat

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引用次数: 0

Abstract

Background and objective: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). It is highly invasive and associated with perioperative risks, while bladder-preserving trimodality therapy (TMT) offers a less invasive alternative with preferable quality of life for selected patients. We aimed to compare oncological outcomes of TMT and RC in MIBC patients, and evaluate TMT-specific outcomes.

Methods: In December 2023, PubMed, Scopus, and Web of Science were searched for studies on MIBC patients treated with TMT. Pairwise meta-analyses were conducted to compare overall survival (OS) and cancer-specific survival (CSS) between MIBC patients treated with TMT and RC, utilizing hazard ratios (HRs). We included only matched cohort studies to minimize selection bias. TMT-specific outcomes, such as response, recurrence, and toxicity rates, were pooled separately.

Key findings and limitations: Eighty-seven studies (n = 28 218) were identified. No significant differences in OS (HR: 1.05; 95% confidence interval [CI]: 0.78-1.40) and CSS (HR: 1.05; 95% CI: 0.69-1.58) were found for TMT compared with RC. In patients treated with TMT, the complete response was achieved in 74.4% (95% CI: 69.1-79.1), the estimated rate of intravesical recurrence was 23.1% (95% CI: 19.0-27.7), and the rate of grade ≥3 acute toxicity was 11.4% (95% CI: 4.0-28.4).

Conclusions and clinical implications: The oncological outcomes of TMT were comparable with those of RC, with an acceptable toxicity profile. TMT appears as a safe and effective treatment for appropriately selected MIBC patients who want to preserve their bladder. However, evidence from high-volume controlled trials is needed.

Patient summary: Well-selected patients with nonmetastatic muscle-invasive bladder cancer can be treated with "trimodality therapy" to preserve the bladder. So far, the reported outcomes are comparable with those of radical surgery, and we found no signs of excess toxicity.

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肌肉浸润性膀胱癌的三联疗法与根治性膀胱切除术：配对队列研究的系统回顾和元分析》。

背景和目的：根治性膀胱切除术（RC）是治疗肌层浸润性膀胱癌（MIBC）的标准疗法。根治性膀胱切除术（RC）是治疗肌层浸润性膀胱癌（MIBC）的标准方法，但其创伤性大，且存在围手术期风险，而保留膀胱的三联疗法（TMT）则是一种创伤性较小的替代方法，可为特定患者提供更好的生活质量。我们旨在比较 TMT 和 RC 对 MIBC 患者的肿瘤治疗效果，并评估 TMT 的特异性效果：2023年12月，我们在PubMed、Scopus和Web of Science上搜索了有关MIBC患者接受TMT治疗的研究。利用危险比（HRs）进行配对荟萃分析，比较接受 TMT 和 RC 治疗的 MIBC 患者的总生存期（OS）和癌症特异性生存期（CSS）。我们仅纳入了匹配队列研究，以尽量减少选择偏倚。TMT的特异性结果，如反应率、复发率和毒性率，分别进行了汇总：共发现 87 项研究（n = 28 218）。TMT与RC相比，在OS（HR：1.05；95% 置信区间[CI]：0.78-1.40）和CSS（HR：1.05；95% 置信区间[CI]：0.69-1.58）方面无明显差异。在接受TMT治疗的患者中，74.4%（95% CI：69.1-79.1）的患者获得了完全应答，估计膀胱内复发率为23.1%（95% CI：19.0-27.7），≥3级急性毒性发生率为11.4%（95% CI：4.0-28.4）：TMT的肿瘤治疗效果与RC相当，毒性也可接受。对于经过适当选择并希望保留膀胱的MIBC患者来说，TMT似乎是一种安全有效的治疗方法。患者总结：经过严格筛选的非转移性肌浸润性膀胱癌患者可以采用 "三联疗法 "来保留膀胱。到目前为止，所报告的疗效与根治性手术的疗效相当，而且我们没有发现过多毒性的迹象。

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

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.