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

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Abstract

Purpose

To determine the effectiveness and harms of bladder-preserving trimodal therapy (TMT) as a first-line treatment versus radical cystectomy (RC) plus radical pelvic lymphadenectomy in the treatment of muscle-invasive bladder cancer in terms of overall survival.

Methods

We included parallel clinical trials and prospective and retrospective cohort studies that included patients older than 18 years old, diagnosed with muscle-invasive bladder cancer, who underwent TMT compared with RC. The planned comparison was TMT versus RC plus pelvic lymphadenectomy as first-line treatment. The primary outcome was overall survival (OS) and secondary outcomes were salvage cystectomy and cancer-specific survival and progression-free survival. A search strategy was designed for MEDLINE, CENTRAL, Embase, and LILACS. We saturated information with conference abstracts, in progress clinical trials, literature published in non-indexed journals, and other sources of gray literature. Standardized tools assessed the risk of bias independently. We performed the statistical analysis in R v3.4.1 and effect sizes were reported in terms of hazard ratios (HR) and the corresponding 95% confidence intervals (95%CI). Accordingly, we used a random effect model due to the statistical heterogeneity found in included studies.

Results

We found 2682 records with the search strategies and, finally, 11 studies were included in the quantitative analysis. The summary HR for OS was 1.06 95%CI (0.85–1.31) I2 = 77%, showing no statistical difference. Regarding cancer-specific survival, the summary HR was 1.23 95%CI (1.04–1.46) I2 = 14%. On the other side, for the progression-free survival, the summary HR was 1.11 95%CI (0.63–1.95) I2 = 78%. Only one study described HR for adverse events (1.37 95%CI 1.16–1.59).

Conclusion

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.

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Abbreviations

TMT:

Bladder preserving trimodal therapy

RC:

Radical cystectomy

BTUR:

Bladder tumor transurethral resection

OS:

Overall survival

CSS:

Cancer specific survival

PFS:

Progression-free survival

HR:

Hazard ratios

SC:

Salvage cystectomy

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PROSPERO:

Prospective register of systematic reviews

MINORS:

Methodological index for non-randomized studies

GRADE:

Grading of recommendations assessment, development and evaluation

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Authors and Affiliations

  1. School of Medicine, Universidad del Valle, Cali, Colombia

    Herney Andrés García-Perdomo & Diego Fernando Castillo

  2. UROGIV Research Group, Universidad del Valle, Cali, Colombia

    Herney Andrés García-Perdomo, Carlos Eduardo Montes-Cardona, Marcela Guacheta & Diego Fernando Castillo

  3. UroScience, School of Medicine, Pontifical Catholic University of Campinas and University of Campinas, Campinas, São Paulo, Brazil

    Leonardo O. Reis

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  1. Herney Andrés García-Perdomo
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Correspondence to Leonardo O. Reis.

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Funding

CNPq Research Productivity, Brazil - grant: 302622/2015-2.

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The authors declare that they have no conflict of interest.

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García-Perdomo, H.A., Montes-Cardona, C.E., Guacheta, M. et al. Muscle-invasive bladder cancer organ-preserving therapy: systematic review and meta-analysis. World J Urol 36, 1997–2008 (2018). https://doi.org/10.1007/s00345-018-2384-6

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