Quimioterapia neoadyuvante con gemcitabina-cisplatino vs metotrexato-vinblastina-adriamicina-cisplatino en pacientes con carcinoma urotelial vesical llevados a cistectomía radical: metaanálisis

Abstract

Background and objectivesBladder urothelial carcinoma is a frequent cause of death among genitourinary tumours in Colombia. Radical cystoprostatectomy is the standard management of muscle invasive bladder urothelial carcinoma (CUMI). Unfortunately, 5-year survival is around 50%, therefore neoadjuvant chemotherapy regimens have been suggested. It has been demonstrated that using neoadjuvant chemotherapy increases overall and disease-free survival. This systematic review included CUMI patients, who received neoadjuvant chemotherapy and subsequent radical cystectomy. Overall mortality and disease-free survival were compared between CUMI patients treated with gemcitabine-cisplatin (GC) or methotrexate-vinblastine-adriamycin-cisplatin (MVAC) neoadjuvant regimens. Materials and methodsThis systematic review was performed using the available literature from 1980 to 2014 to identify clinical studies. Studies had to include patients with muscle invasive bladder urothelial carcinoma, who underwent radical cystoprostatectomy, and that compare overall mortality and disease-free survival of GC neoadjuvant versus MVAC scheme. Bias assessment and data extraction was performed by independent evaluators. Meta-analysis techniques were performed where possible, depending on the observed heterogeneity. The data were processed using Stata version 12 statistical program. ResultsSix non-randomised clinical studies were included. There were 184 patients assigned to a GC scheme and 228 patients in the MVAC group. No significant statistically differences were found in overall mortality with OR: 2.23 (95%CI: 0.87-5.67), cancer specific mortality for GC was 50% compared to MVAC 61% (P=.48), and complete disease response, OR: 1.34 (95%CI: 0.79-2.29). Higher relapse likelihood among patients with GC scheme was found, OR: 2.73 (95%CI: 1.1-6.75). ConclusionsThe available evidence comparing neoadjuvant regimes such as gemcitabine-cisplatin vs methotrexate-vinblastine-adriamycin-cisplatin is limited and lacks randomised studies. The evidence provides similar results with both cancer neoadjuvant chemotherapy regimens.