浸润性膀胱癌的新辅助化疗：晚期膀胱癌（ABC）荟萃分析协作组对个体患者数据的系统评价和荟萃分析更新
Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration.
出版信息
Eur Urol. 2005 Aug;48(2):202-5; discussion 205-6. doi: 10.1016/j.eururo.2005.04.006. Epub 2005 Apr 21.
OBJECTIVES
To update a systematic review and meta-analysis that assesses the effect of neoadjuvant chemotherapy in the treatment of patients with invasive bladder cancer.
METHODS
Following a prespecified protocol, we analysed updated individual patient data from all eligible randomised controlled trials that compared neoadjuvant chemotherapy plus local treatment with the same local treatment alone.
RESULTS
Updated results are based on 11 trials, 3005 patients; comprising 98% of all patients from known eligible randomised controlled trials. We found a significant survival benefit associated with platinum-based combination chemotherapy (HR = 0.86, 95% CI 0.77-0.95, p = 0.003). This is equivalent to a 5% absolute improvement in survival at 5 years. There was also a significant disease-free survival benefit associated with platinum-based combination chemotherapy (HR = 0.78 95% CI 0.71-0.86, p < 0.0001), equivalent to a 9% absolute improvement at 5 years.
CONCLUSIONS
These results provide the best available evidence in support of the use of neoadjuvant platinum-based combination chemotherapy.
目的
更新一项系统评价和荟萃分析，评估新辅助化疗在浸润性膀胱癌患者治疗中的效果。
方法
按照预先指定的方案，我们分析了所有符合条件的随机对照试验的最新个体患者数据，这些试验比较了新辅助化疗加局部治疗与单纯相同局部治疗的效果。
结果
更新后的结果基于11项试验，共3005例患者；占已知符合条件的随机对照试验中所有患者的98%。我们发现铂类联合化疗具有显著的生存获益（风险比=0.86，95%置信区间0.77-0.95，p=0.003）。这相当于5年生存率绝对提高了5%。铂类联合化疗在无病生存方面也有显著获益（风险比=0.78，95%置信区间0.71-0.86，p<0.0001），相当于5年时绝对提高了9%。
结论
这些结果为支持使用铂类新辅助联合化疗提供了现有最佳证据。
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