Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.
Men's Health and Reproductive Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BJU Int. 2021 Sep;128(3):280-289. doi: 10.1111/bju.15383. Epub 2021 May 3.
OBJECTIVE: To assess whether single immediate intravesical chemotherapy (SIIC) adds value to bladder tumour management in combination with novel optical techniques: enhanced transurethral resection of bladder tumour (TURBT). METHODS: A systematic search was performed using the PubMed and Web of Science databases in September 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) extension statement for network meta-analyses. Studies that compared recurrence rates among intervention groups (TURBT with photodynamic diagnosis [PDD] ± SIIC, narrow-band imaging [NBI] ± SIIC, or white-light cystoscopy [WLC] + SIIC) and a control group (TURBT with WLC alone) were included. We used the Bayesian approach in the network meta-analysis. RESULTS: Twenty-two studies (n = 4519) met our eligibility criteria. Out of six different interventions including three different optical techniques, compared to WLC alone, blue-light cystoscopy (BLC) plus SIIC (odds ratio [OR] 0.349, 95% credible interval [CrI] 0.196-0.601) and BLC alone (OR 0.668, 95% CrI 0.459-0.931) were associated with a significantly lower likelihood of 12-month recurrence rate. In the sensitivity analysis, out of eight different interventions compared to WLC alone, PDD by 5-aminolevulinic acid plus SIIC (OR 0.327, 95% CrI 0.159-0.646) and by hexaminolevulinic acid plus SIIC (OR 0.376, 95% CrI 0.172-0.783) were both associated with a significantly lower likelihood of 12-month recurrence rate. NBI with and without SIIC was not associated with a significantly lower likelihood of 12-month recurrence rate (OR 0.385, 95% CrI 0.105-1.29 and OR 0.653, 95% CrI 0.343-1.15). CONCLUSION: Blue-light cystoscopy during TURBT with concomitant SIIC seems to yield superior recurrence outcomes in patients with non-muscle-invasive bladder cancer. The use of PDD was able to reduce the 12-month recurrence rate; moreover, concomitant SIIC increased this risk benefit by a 32% additional reduction in odds ratio. Although using PDD could reduce the recurrence rate, SIIC remains necessary. Moreover, ranking analysis showed that both PDD and NBI, plus SIIC, were better than these techniques alone.
目的：评估单次即刻膀胱内化疗（SIIC）联合新型光学技术（增强经尿道膀胱肿瘤切除术[TURBT]）是否对膀胱癌管理具有附加价值。
方法：根据系统评价和荟萃分析的首选报告项目（PRISMA）扩展声明，于 2020 年 9 月在 PubMed 和 Web of Science 数据库中进行系统检索。纳入比较干预组（TURBT 联合光动力诊断[PDD]±SIIC、窄带成像[NBI]±SIIC 或白光膀胱镜检查[WLC]+SIIC）与对照组（单独接受 TURBT 与 WLC）之间复发率的研究。我们在网络荟萃分析中使用贝叶斯方法。
结果：22 项研究（n=4519）符合入选标准。在包括三种不同光学技术的六种不同干预措施中，与单独接受 WLC 相比，蓝激光膀胱镜检查（BLC）联合 SIIC（比值比[OR]0.349，95%可信区间[CrI]0.196-0.601）和单独接受 BLC（OR 0.668，95%CrI 0.459-0.931）的 12 个月复发率显著降低。在敏感性分析中，与单独接受 WLC 相比，在包括八种不同干预措施中，5-氨基酮戊酸-PDD 联合 SIIC（OR 0.327，95%CrI 0.159-0.646）和六氨基酮戊酸-PDD 联合 SIIC（OR 0.376，95%CrI 0.172-0.783）均与 12 个月复发率显著降低相关。NBI 联合和不联合 SIIC 与 12 个月复发率无显著降低相关（OR 0.385，95%CrI 0.105-1.29 和 OR 0.653，95%CrI 0.343-1.15）。
结论：TURBT 期间行蓝激光膀胱镜检查联合同时行 SIIC 似乎可改善非肌层浸润性膀胱癌患者的复发结局。PDD 的应用可降低 12 个月复发率；此外，同时行 SIIC 可将比值比额外降低 32%，进一步增加这种风险获益。虽然使用 PDD 可以降低复发率，但仍需要进行 SIIC。此外，排名分析显示，PDD 和 NBI 联合 SIIC 均优于单独使用这些技术。
Cochrane Database Syst Rev. 2022-4-8
Cochrane Database Syst Rev. 2017-9-12
Cochrane Database Syst Rev. 2021-12-1
Cochrane Database Syst Rev. 2003
Cancers (Basel). 2022-6-29
Zotero 插件
