Abstract
BackgroundMitomycin (MMC) has been frequently used as the compound for intravesical treatment. The relatively new pyrimidine analog gemcitabine (GEM) has exhibited anticancer effect on various solid cancers, such as the advanced bladder cancer. In this study, the GEM and MMC in treating non-muscle invasive bladder cancer (NMIBC) cases was compared through systemic review.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the electronic databases, including Embase, PubMed, Chinese biomedicine literature database, the Cochrane Library, the National Institute for Health and Clinical Excellence, NHS Evidence, Chinese technological periodical full-text database, and Chinese periodical full-text database, were systemically reviewed from inception to October 2018. Then, the RevMan 5.0 software was applied for data analysis. Five randomized controlled trials (RCTs) involving a total of 335 patients were included.ResultsFor MMC group, the recurrence rate in the mitomycin arm increased compared with that in GEM group (OR = 0.44 95% CI [0.24, 0.78]), and the difference was statistically significant between the two groups. GEM was associated with reduced incidence of chemical cystitis compared with that of MMC (OR = 0.23 95% CI [0.12, 0.44]). Differences in hematuria (OR = 0.46 95% CI [0.16, 1.31]), skin reaction (OR = 0.49 95% CI [0.14, 1.70]) and liver and kidney function damage (OR = 0.51 95% CI [0.09, 2.85]) displayed no statistical significance between the two groups.ConclusionFindings in our study demonstrate the superior efficacy of GEM over MMC in reducing the relapse rate among NMIBC patients following transurethral resection (TUR). In addition, GEM is associated with reduced local toxic effects on the bladder compared with those of MMC. However, more future studies are needed to examine GEM safety when used as the monotherapy or polytherapy for bladder patients. More RCTs with high quality are also required to validate our findings due to the limitations of the current meta-analysis.
Highlights
Mitomycin (MMC) has been frequently used as the compound for intravesical treatment
Findings in our study demonstrate the superior efficacy of GEM over Mitomycin C (MMC) in reducing the relapse rate among non-muscle invasive bladder cancer (NMIBC) patients following transurethral resection (TUR)
The entire retrieval strategy adopted in the current work for the PubMed database included AND AND (GEM OR gemcitabine) AND (MMC OR mitomycin OR mitomycin-c)
Summary
Mitomycin (MMC) has been frequently used as the compound for intravesical treatment. The relatively new pyrimidine analog gemcitabine (GEM) has exhibited anticancer effect on various solid cancers, such as the advanced bladder cancer. The GEM and MMC in treating non-muscle invasive bladder cancer (NMIBC) cases was compared through systemic review. Bladder cancer has become a common cancer worldwide, and 430,000 new cases and over 165,000 deaths are reported in 2012 [1]. Tumor relapse following transurethral resection (TUR) has been identified as a main issue in treating non-muscle invasive bladder cancer. The mechanisms regarding NMIBC relapse following TUR are shown as follows, (1) residual tumor originated from the incomplete resection; (2) floating cancer cell implantation in traumatized bladder sites; (3) incidence of new neoplasm due to high cancer aggressiveness; (4) relapses at the urothelial instability sites (atypia, hyperplasia and dysplasia) [7]; (5) over 50–70% tumor relapse since no adjuvant treatment is given, and approximately 15% cases develop muscle-invasive cancers eventually [8]
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