You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2018MP78-18 BLADDER PRESERVATION THERAPY FOR THE TREATMENT OF MUSCLE INVASIVE BLADDER CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS Teruo Inamoto, Naokazu Ibuki, Kazumasa Komura, Koichiro Minami, Tomoaki Takai, Taizo Uchimoto, Kenkichi Saito, Naoki Tanda, Takuya Tsujino, Tomohisa Matsunaga, Yuki Yoshikawa, Hajime Hirano, Hayahito Nomi, Hiroshi Juri, Kiyohito Yamamoto, Kazuhiro Yamamoto, Yoshifumi Narumi, and Haruhito Azuma Teruo InamotoTeruo Inamoto More articles by this author , Naokazu IbukiNaokazu Ibuki More articles by this author , Kazumasa KomuraKazumasa Komura More articles by this author , Koichiro MinamiKoichiro Minami More articles by this author , Tomoaki TakaiTomoaki Takai More articles by this author , Taizo UchimotoTaizo Uchimoto More articles by this author , Kenkichi SaitoKenkichi Saito More articles by this author , Naoki TandaNaoki Tanda More articles by this author , Takuya TsujinoTakuya Tsujino More articles by this author , Tomohisa MatsunagaTomohisa Matsunaga More articles by this author , Yuki YoshikawaYuki Yoshikawa More articles by this author , Hajime HiranoHajime Hirano More articles by this author , Hayahito NomiHayahito Nomi More articles by this author , Hiroshi JuriHiroshi Juri More articles by this author , Kiyohito YamamotoKiyohito Yamamoto More articles by this author , Kazuhiro YamamotoKazuhiro Yamamoto More articles by this author , Yoshifumi NarumiYoshifumi Narumi More articles by this author , and Haruhito AzumaHaruhito Azuma More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2566AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The effect of bladder preserving tri-modal therapy (TMT) on muscle invasive bladder cancer (MIBC) prognosis has been investigated in several studies with inconsistent results in the lack of level 1 evidence. We investigated whether TMT for MIBC were associated with favorable prognosis in comparison with radical cystectomy (RC). METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a combination of MeSH® terms, free text search and examination of relevant bibliographies using MEDLINE® and Embase® from the inception of each database conducted between 1997 and 2012. Prospective phase 2-3 trials were included. We excluded studies describing TMT for non-muscle invasive disease, case reports and series where treatment was followed by adjuvant chemotherapy or radiotherapy. A meta-analysis was performed using the random effects model. RESULTS A total of 22 studies (TMT/RC: 13/9) that enrolled 3924 patients were included. Rates of overall survival ranged from 23% to 77% for TMT and 13% to 53% for RC, respectively, with definitions varying by study. The odds ratio (OR) of survival of patients treated with TMT or RC was 0.88 (95% CI = 0.77–1.01) with a small benefit of 3% in favor of the former. The OR of survival from TMT including gemcitabine based chemotherapy was significantly better versus the group treated with RC (OR = 0.69; 95% CI = 0.55–0.88), but not versus whole TMT cohort (OR = 0.79; 95% CI = 0.61–1.01). Eleven TMT trials used cisplatin based chemotherapy and the OR to whole TMT cohort was 0.89 (95% CI 0.75 to 1.04). Meta-analysis revealed no overall association between lymph node status and overall survival rate (pooled HR 1.00, 95% CI 0.85–1.18). CONCLUSIONS The body of evidence is limited due to the absence of randomized prospective studies. However, the results from this meta-analysis unambiguously support the hypothesis that MIBC patients treated with TMT are at similar risk for death to RC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1044 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Teruo Inamoto More articles by this author Naokazu Ibuki More articles by this author Kazumasa Komura More articles by this author Koichiro Minami More articles by this author Tomoaki Takai More articles by this author Taizo Uchimoto More articles by this author Kenkichi Saito More articles by this author Naoki Tanda More articles by this author Takuya Tsujino More articles by this author Tomohisa Matsunaga More articles by this author Yuki Yoshikawa More articles by this author Hajime Hirano More articles by this author Hayahito Nomi More articles by this author Hiroshi Juri More articles by this author Kiyohito Yamamoto More articles by this author Kazuhiro Yamamoto More articles by this author Yoshifumi Narumi More articles by this author Haruhito Azuma More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...