Deb Abdalla Ali, Agag Ayman, Naushad Naufal, Krishnamoorthy Rajbabu, Serag Hosam
Department of Urology, Aberdeen Royal Inrmary, Aberdeen, United Kingdom.
Department of Urology, Frimley Park Hospital, Camberely, United Kingdom.
Turk J Urol. 2021 Jul;47(4):260-269. doi: 10.5152/tju.2021.21086.
Some studies suggest that chemoresection with mitomycin C (MMC) is comparable to transurethral resection of bladder tumor (TURBT) in the management of recurrent nonmuscle-invasive bladder cancer (NMIBC). In this meta-analysis, we compared the efficacy and safety of MMC and TURBT in recurrent NMIBC. A search was conducted for studies published in English in the electronic databases of MEDLINE/PubMed, the Cochrane Library, Scopus, Web of Science, Google Scholar, ProQuest, System for information on Grey Literature, and ClinicalTrials.gov, with no publication date restrictions. Risk of bias was assessed using the Risk of bias 2 tool for randomized controlled trials and Risk of Bias inNon-Randomized Studies of Interventions-I tool for observational studies. Data analysis was performed using the RevMan 5.4 software. Three studies were included in this systematic review(total participants is 291); two studieswere included in themeta-analysis. The rate of complete response was significantly lower in MMC group compared with TURBT (relative risk [RR]: 0.55, 95% confidence interval (CI): 0.45-0.67, P< .001). The rates of local adverse events were lower inMMC, with a statistical significance for dysuria (RR: 0.55, 95% CI: 0.36-0.84, P ¼ .006), urinary frequency (RR: 0.60, 95% CI: 0.43- 0.84, P¼ .003), cystitis (RR: 0.22, 95% CI: 0.06-0.81, P¼ .02), and incontinence (RR: 0.48, 95% CI: 0.24-0.96, P¼ .04). In terms of complete response, TURBT is superior to chemoresection withMMC. Currently, chemoresection withMMC should be restricted to patients unfit for surgery and in clinical trials. Future randomized controlled trials are recommended to confirm or refute the use ofMMC in treating recurrent NMIBC.
一些研究表明，在复发性非肌层浸润性膀胱癌（NMIBC）的治疗中，丝裂霉素C（MMC）化学切除术与经尿道膀胱肿瘤切除术（TURBT）效果相当。在这项荟萃分析中，我们比较了MMC和TURBT治疗复发性NMIBC的疗效和安全性。我们在MEDLINE/PubMed、Cochrane图书馆、Scopus、科学网、谷歌学术、ProQuest、灰色文献信息系统和ClinicalTrials.gov等电子数据库中检索了以英文发表的研究，无出版日期限制。使用随机对照试验的偏倚风险2工具和观察性研究的干预性非随机研究中的偏倚风险-I工具评估偏倚风险。使用RevMan 5.4软件进行数据分析。本系统评价纳入了3项研究（总参与者291人）；荟萃分析纳入了2项研究。与TURBT相比，MMC组的完全缓解率显著更低（相对风险[RR]：0.55，95%置信区间[CI]：0.45 - 0.67，P <.001）。MMC组的局部不良事件发生率更低，在尿痛方面具有统计学意义（RR：0.55，95% CI：0.36 - 0.84，P = .006）；尿频（RR：0.60，95% CI：0.43 - 0.84，P = .003）；膀胱炎（RR：0.22，95% CI：0.06 - 0.81，P = .02）；以及尿失禁（RR：0.48，95% CI：0.24 - 0.96，P = .04）。在完全缓解方面，TURBT优于MMC化学切除术。目前，MMC化学切除术应仅限于不适合手术的患者以及临床试验中。建议未来进行随机对照试验以证实或反驳MMC在治疗复发性NMIBC中的应用。
