Bladder-sparing trimodal therapy versus radical cystectomy for muscleinvasive bladder cancer: A systematic review and meta-analysis of comparative studies

Objective: To compare oncologic outcomes between patients with muscle-invasive bladder cancer who were treated with radical cystectomy (RC) or trimodal therapy (TMT). Materials and Methods: The primary sources were the PubMed, Embase, and Cochrane Library electronic databases. Studies published between June 1990 and July 2017 that evaluated combination bladder-sparing surgery for a bladder tumour with radiotherapy (RT) and chemotherapy compared with RC surgery alone for MIBC were included. Published data were extracted and used to calculate the 5-year overall survival rates. The secondary efficacy endpoints were disease-free survival and local and distant recurrence. Results: Nine studies incorporating 15,160 cases were included in the final analysis. Pooled data from 8 studies that assessed overall survival rates for 15,089 patients showed no significant differences in this metric between the TMT and RC groups (HR: 1.27; 95% CI, 0.98-1.63; P=0.066). No significant differences were found between TMT and RC in the subgroup analyses according to the lymph node stage (Nx), age and physiclal status (PS) stage, but differences were found for patients with node-negative disease (HR: 1.36; 95% CI, 1.02-1.81; P=0.036). Disease-free survival and local and distant recurrence did not differ significantly between the techniques. Conclusion: RC seems to be suitable for node-negative disease patients. TMT yielded survival outcomes similar to those of patients who underwent RC. Given the inherent limitations of the included studies, future well-designed RCTs are needed to confirm and update the findings of this analysis.