Division of Urology, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia.
Urology Program, Universidad de Cartagena, Cartagena, Colombia.
Urol Oncol. 2022 May;40(5):200.e11-200.e18. doi: 10.1016/j.urolonc.2022.02.014. Epub 2022 Mar 17.
To determine the effectiveness of adjuvant chemotherapy compared with neoadjuvant chemotherapy in patients with node-positive penile cancer in terms of overall and disease-free survival.
We conducted a search strategy in MEDLINE, Embase, and Central databases. We complemented the search with unpublished literature through manual search, conferences, thesis databases, Open Grey, Google Scholar, and Clinicaltrials.gov. There were no restrictions in language. We used the MINORS tool to assess the risk of bias. Furthermore, we performed a random-effects meta-analysis according to the expected heterogeneity. The outcomes were overall survival, progression-free survival, and adverse effects. The Effect measure was hazard ratio (HR) with a confidence interval of 95%.
We included 1,197 patients. Seven articles reported overall survival; while 3 reported progression-free survival. The pooled overall survival HR was 1.41 (0.99-2.02), while the progression-free survival HR was 1.63 (1.09-2.44) for adjuvant vs neoadjuvant therapy. An analysis of adverse effects was not possible.
There were no differences when comparing adjuvant vs. neoadjuvant chemotherapy or adjuvant vs. no intervention chemotherapy. We conclude that progression-free survival had a better response with adjuvant chemotherapy when compared with neoadjuvant therapy. We suggest more studies with adequate design to offer a stronger recommendation.
比较辅助化疗与新辅助化疗在有淋巴结阳性的阴茎癌患者中的总体生存率和无病生存率。
我们在 MEDLINE、Embase 和中央数据库中进行了搜索策略。我们通过手动搜索、会议、论文数据库、Open Grey、Google Scholar 和 Clinicaltrials.gov 等方式补充了未发表的文献。语言不受限制。我们使用 MINORS 工具评估偏倚风险。此外，我们根据预期异质性进行了随机效应荟萃分析。结局为总生存率、无进展生存率和不良反应。效应量为危险比（HR），置信区间为 95%。
我们纳入了 1197 名患者。有 7 篇文章报告了总生存率，3 篇文章报告了无进展生存率。辅助化疗与新辅助化疗的总生存率 HR 为 1.41（0.99-2.02），无进展生存率 HR 为 1.63（1.09-2.44）。不良反应的分析是不可能的。
辅助化疗与新辅助化疗或辅助化疗与无干预化疗相比，无差异。我们得出结论，与新辅助治疗相比，辅助化疗对无进展生存率有更好的反应。我们建议进行更多设计合理的研究，以提供更强的推荐。
