Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
PLoS One. 2019 Apr 29;14(4):e0216255. doi: 10.1371/journal.pone.0216255. eCollection 2019.
To systematically review and meta-analyze the current literature in a methodologically rigorous and transparent manner for quantitative evidence on survival outcomes among patients diagnosed with muscle-invasive bladder cancer that were treated by either trimodal therapy or radical cystectomy.
MEDLINE, EMBASE, CENTRAL were systematically searched for comparative observational studies reporting disease-specific survival and/or overall survival on adult patients diagnosed with localized muscle-invasive bladder cancer that were exposed to either trimodal therapy or radical cystectomy. Studies qualified for meta-analysis (random effects model) if they were not at critical risk of bias (RoB).
The literature search identified 12 eligible studies. Three (all rated as "moderate RoB") out of 6 studies reporting on disease-specific survival qualified for quantitative analysis and yielded a pooled hazard ratio (trimodal therapy versus radical cystectomy) of 1.39 (95% confidence interval: 1.03-1.88). Four (mainly rated as "serious RoB") out of 12 studies were included in the meta-analysis of overall survival and estimated a hazard ratio of 1.39 (1.20-1.59).
Pooled results were significant in favor of radical cystectomy. The conclusion is mainly driven by large population-based studies that are at high RoB. Hence, the certainty of these treatment estimates can be considered very low and further research will likely have an important impact on these estimates. At present, the ultimate decision between trimodal therapy and radical cystectomy should be left to the patient based on individual preferences and on the recommendation of a multidisciplinary provider team experienced with both approaches.
以系统和透明的方式对现有文献进行综述和荟萃分析，以获取关于接受三联疗法或根治性膀胱切除术治疗的肌层浸润性膀胱癌患者生存结局的定量证据。
系统检索了 MEDLINE、EMBASE 和 CENTRAL，以寻找报告接受三联疗法或根治性膀胱切除术治疗的局限性肌层浸润性膀胱癌成人患者的疾病特异性生存和/或总体生存的比较观察性研究。如果研究没有处于关键偏倚风险（RoB），则符合荟萃分析（随机效应模型）的条件。
文献检索确定了 12 项合格的研究。6 项报告疾病特异性生存的研究中有 3 项（均被评为“中度 RoB”）符合定量分析条件，得出三联疗法与根治性膀胱切除术相比的合并危险比（HR）为 1.39（95%置信区间：1.03-1.88）。12 项研究中有 4 项（主要被评为“严重 RoB”）被纳入总体生存的荟萃分析，估计 HR 为 1.39（1.20-1.59）。
汇总结果明显有利于根治性膀胱切除术。这一结论主要由高 RoB 的大型基于人群的研究驱动。因此，这些治疗估计的确定性可被认为非常低，进一步的研究可能会对这些估计产生重要影响。目前，三联疗法和根治性膀胱切除术之间的最终选择应根据患者的个人偏好，并根据经验丰富的多学科提供者团队对这两种方法的建议，由患者做出决定。
