Abstract
We performed a network meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of several intravesical chemotherapeutic (IVC) agents after transurethral resection of bladder tumor (TURB) in non-muscle invasive bladder cancer patients. The literature search was conducted using the Embase, Scopus and PubMed databases for RCTs, including patients with single or multiple, primary or recurrent stage Ta or T1 urothelial carcinoma of the bladder managed with a single, immediate instillation of IVC after TURB. Thirteen RCTs met the eligibility criteria. Pair-wise meta-analysis (direct comparison) showed that pirarubicin [hazard ratio (HR): 0.31], epirubicin (HR: 0.62), and MMC (HR: 0.40) were the most effective drugs for reducing tumor recurrence. Bayesian network meta-analysis (indirect comparison) revealed that treatment with pirarubicin (HR: 0.31), MMC (HR: 0.44), or epirubicin (HR: 0.60) was associated with prolonged recurrence-free survival. Among the drugs examined, only pirarubicin reduced disease progression compared to controls. These results suggest that a single, immediate administration of IVC with pirarubicin, MMC, or epirubicin is associated with prolonged recurrence-free survival following TURB in non-muscle invasive bladder cancer patients, though only pirarubicin also reduced disease progression.
Highlights
Bladder cancer, the incidence of which has increased over the last decade, is the fourth most common malignancy in men and the eighth most common in women, with 429,000 new cases and 165,000 deaths reported worldwide in 2012; it is the second most common cause of death due to urological cancer [1]
Instillation of intravesical chemotherapy (IVC) is generally recommended immediately after complete transurethral resection of bladder tumor (TURB), especially in patients with low- or intermediate-risk nonmuscle invasive bladder cancers (NMIBCs) or with small-volume, low-grade Ta NMIBC based on European Association of Urology (EAU) and American Urological Association (AUA) guidelines, respectively [3, 4]
Despite accumulating evidence that post-TUR IVC instillation reduces disease recurrence, many clinicians are still reluctant to apply this intervention in patients with NMIBC due to the cost, postoperative care requirements, and unexpected side effects, such as irritative lower urinary tract symptoms, rare hypersensitivity reactions, and extravasation of IVC agents [5, 6]
Summary
The incidence of which has increased over the last decade, is the fourth most common malignancy in men and the eighth most common in women, with 429,000 new cases and 165,000 deaths reported worldwide in 2012; it is the second most common cause of death due to urological cancer [1]. Because nonmuscle invasive bladder cancers (NMIBCs) may recur and progress to muscle-invasive disease after initial treatment [2], it is necessary to develop efficient therapeutic strategies that reduce recurrence and/or progression. Despite accumulating evidence that post-TUR IVC instillation reduces disease recurrence, many clinicians are still reluctant to apply this intervention in patients with NMIBC due to the cost, postoperative care requirements, and unexpected side effects, such as irritative lower urinary tract symptoms, rare hypersensitivity reactions, and extravasation of IVC agents [5, 6]. Previous studies have primarily focused on the clinical benefits of postoperative IVC in general rather than comparing outcomes associated with different drugs. Various IVC agents may have differing effects on oncological outcomes in NMIBC patients who receive a single, immediate administration regimen following TURB
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