Lancet. 2003 Jun 7;361(9373):1927-34. doi: 10.1016/s0140-6736(03)13580-5.
Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease.
We analysed updated data for 2688 individual patients from ten available randomised trials.
Platinum-based combination chemotherapy showed a significant benefit to overall survival (combined hazard ratio [HR] 0.87 [95% CI 0.78-0.98, p=0.016]; 13% reduction in risk of death; 5% absolute benefit at 5 years [1-7]; overall survival increased from 45% to 50%). This effect was observed irrespective of the type of local treatment, and did not vary between subgroups of patients. The HR for all trials, including those using single-agent cisplatin, tended to favour neoadjuvant chemotherapy (HR=0.91, 95% CI 0.83-1.01) although this tendency was not significant (p=0.084). Although platinum based combination chemotherapy was beneficial, there was no evidence to support the use of single-agent platinum; indeed, there was a significant difference in the effect between these groups of trials (p=0.044).
This improvement in survival encourages the use of platinum-based combination chemotherapy for patients with invasive bladder cancer.
尽管有超过3000例患者的随机对照试验，但对于新辅助化疗是否能提高浸润性膀胱癌患者的生存率仍存在争议。我们进行了一项系统评价和荟萃分析，以评估这种治疗对该疾病患者生存率的影响。
我们分析了来自10项现有随机试验的2688例个体患者的更新数据。
铂类联合化疗对总生存显示出显著益处（合并风险比[HR]0.87[95%CI0.78 - 0.98，p = 0.016]；死亡风险降低13%；5年时绝对获益5%[1 - 7]；总生存率从45%提高到50%）。无论局部治疗的类型如何，均观察到这种效果，且在患者亚组之间无差异。所有试验（包括使用单药顺铂的试验）的HR倾向于支持新辅助化疗（HR = 0.91，95%CI0.83 - 1.01），尽管这种倾向不显著（p = 0.084）。虽然铂类联合化疗有益，但没有证据支持使用单药铂类；实际上，这些试验组之间的效果存在显著差异（p = 0.044）。
生存率的这种提高鼓励对浸润性膀胱癌患者使用铂类联合化疗。
