窄带成像辅助经尿道切除术降低非肌层浸润性膀胱癌的复发风险：一项系统评价和荟萃分析。

Narrow band imaging-assisted transurethral resection reduces the recurrence risk of non-muscle invasive bladder cancer: A systematic review and meta-analysis.

作者信息

Kang Weiting, Cui Zilian, Chen Qianqian, Zhang Dong, Zhang Haiyang, Jin Xunbo

机构信息

Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.

School of Medicine, Shandong University, Jinan, Shandong, China.

出版信息

Oncotarget. 2017 Apr 4;8(14):23880-23890. doi: 10.18632/oncotarget.13054.

CONTEXT

Compared with white light imaging (WLI) cystoscopy, narrow band imaging (NBI) cystoscopy could increase the visualization and detection of bladder cancer (BC) at the time of transurethral resection (TUR). NBI cystoscopy could increase the detection of BC, but it remains unclear whether narrow band imaging-assisted transurethral resection (NBI-TUR) could reduce the recurrence risk of non-muscle invasive bladder cancer (NMIBC). Several randomized clinical trials (RCTs) have recently tested the efficacy of NBI-TUR for NMIBC.

OBJECTIVE

To perform a systematic review and meta-analysis of RCTs and evaluate the efficacy of NBI-TUR for NMIBC compared with white light imaging-assisted transurethral resection (WLI-TUR). The end point was recurrence risk.

EVIDENCE ACQUISITION

A systematic review of PubMed, Medline, Ovid, Embase, Cochrane and Web of Science was performed in February 2016 and updated in July 2016.

EVIDENCE SYNTHESIS

Overall, six (n = 1084) of 278 trials were included. Three trials performed narrow band imaging-assisted electro-transurethral resection (NBI-ETUR), and two trials performed narrow band imaging-associated bipolar plasma vaporization (NBI-BPV). The last trial performed narrow band imaging-associated holmium laser resection (NBI-HLR). Statistical analysis was performed using Review Manager software (RevMan v.5.3; The Nordic Cochrane Center, Copenhagen, Denmark). The recurrence risk was compared by calculating risk ratios (RRs) with 95% confidence interval (CIs). Risk ratios with 95% CIs were calculated to compare 3-mo, 1-yr, and 2-yr survival rates. NBI-TUR was associated with improvements in the 3-mo recurrence risk (RR: 0.39; 95% CI, 0.26-0.60; p < 0.0001), 1-yr recurrence risk (RR: 0.52; 95% CI, 0.40-0.67; p < 0.00001) and 2-yr recurrence risk (RR: 0.60; 95% CI, 0.42-0.85; p = 0.004) compared with WLI-TUR.

CONCLUSIONS

Compared with WLI-TUR, NBI-TUR can reduce the recurrence risk of NMIBC. The results of this review will facilitate the appropriate application of NBI in NMIBC.

背景

与白光成像（WLI）膀胱镜检查相比，窄带成像（NBI）膀胱镜检查可在经尿道切除术（TUR）时提高膀胱癌（BC）的可视化及检测率。NBI膀胱镜检查可增加BC的检测率，但窄带成像辅助经尿道切除术（NBI-TUR）是否能降低非肌层浸润性膀胱癌（NMIBC）的复发风险仍不清楚。最近有几项随机临床试验（RCT）对NBI-TUR治疗NMIBC的疗效进行了测试。

目的

对RCT进行系统评价和荟萃分析，评估NBI-TUR治疗NMIBC相较于白光成像辅助经尿道切除术（WLI-TUR）的疗效。终点指标为复发风险。

证据收集

2016年2月对PubMed、Medline、Ovid、Embase、Cochrane和Web of Science进行了系统评价，并于2016年7月更新。

证据综合

总体而言，278项试验中有6项（n = 1084）被纳入。3项试验进行了窄带成像辅助经尿道电切术（NBI-ETUR），2项试验进行了窄带成像相关双极等离子体汽化术（NBI-BPV）。最后一项试验进行了窄带成像相关钬激光切除术（NBI-HLR）。使用Review Manager软件（RevMan v.5.3；丹麦哥本哈根北欧Cochrane中心）进行统计分析。通过计算风险比（RRs）及95%置信区间（CIs）比较复发风险。计算95%CI的风险比以比较3个月、1年和2年生存率。与WLI-TUR相比，NBI-TUR在3个月复发风险（RR：0.39；95%CI，0.26 - 0.60；p < 0.0001）、1年复发风险（RR：0.52；95%CI，0.40 - 0.67；p < 0.00001）和2年复发风险（RR：0.60；95%CI，0.42 - 0.85；p = 0.004）方面有改善。