Chung Doo Yong, Kang Dong Hyuk, Kim Jong Won, Ha Jee Soo, Kim Do Kyung, Cho Kang Su
Department of Urology, Inha University School of Medicine, Incheon 22212, Korea.
Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
Cancers (Basel). 2021 Jun 2;13(11):2770. doi: 10.3390/cancers13112770.
Platinum-based neoadjuvant chemotherapy (NAC) is widely used for treating muscle-invasive bladder cancer (MIBC). A systematic review was performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2020. We conducted a meta-analysis to compare the oncologic outcomes of ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), which are the most widely used NAC regimens. Endpoints included pathologic complete response (pCR), pathologic downstaging (pDS), overall survival (OS), and cancer-specific survival (CSS). Five studies, with a total of 1206 patients, were included for meta-analysis. pCR was observed in 35.2% of the ddMVAC arm and in 25.1% of the GC arm, and pCR was significantly higher in ddMVAC than in GC (odds ratio (OR), 1.45; 95% confidence interval (CI), 1.11-1.89; = 0.006). There was no significant difference in pDS (OR, 1.37; CI, 0.84-2.21; = 0.20). OS was significantly higher in ddMVAC than in GC (hazard ratio, 2.16; CI, 1.42-3.29; = 0.0004). Only one study reported CSS outcomes. The results of this analysis indicate that ddMVAC is superior to GC in terms of pCR and OS, suggesting that ddMVAC is more effective than GC in NAC for MIBC. However, this should be interpreted with caution because of the inherent limitations of retrospective studies.
铂类新辅助化疗（NAC）被广泛用于治疗肌肉浸润性膀胱癌（MIBC）。按照PRISMA指南进行了一项系统评价。检索了截至2020年12月的PubMed、Embase和Cochrane图书馆。我们进行了一项荟萃分析，以比较ddMVAC（剂量密集型甲氨蝶呤、长春碱、阿霉素和顺铂）和GC（吉西他滨和顺铂）这两种最广泛使用的NAC方案的肿瘤学结局。终点包括病理完全缓解（pCR）、病理降期（pDS）、总生存期（OS）和癌症特异性生存期（CSS）。五项研究共纳入1206例患者进行荟萃分析。ddMVAC组pCR发生率为35.2%，GC组为25.1%，ddMVAC组pCR显著高于GC组（优势比（OR）为1.45；95%置信区间（CI）为1.11-1.89；P = 0.006）。pDS无显著差异（OR为1.37；CI为0.84-2.21；P = 0.20）。ddMVAC组OS显著高于GC组（风险比为2.16；CI为1.42-3.29；P = 0.0004）。只有一项研究报告了CSS结局。该分析结果表明，在pCR和OS方面，ddMVAC优于GC，提示在MIBC的NAC中，ddMVAC比GC更有效。然而，由于回顾性研究的固有局限性，对此应谨慎解读。
