变异组织学类型膀胱癌的新辅助和辅助化疗：系统评价与荟萃分析

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis.

作者信息

Zhu Ziwei, Xiao Yunyuan, Hu Shengye, Wang Ziyuan, Zhu Zaisheng

机构信息

Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, JinHua, China.

Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Front Oncol. 2022 Jul 14;12:907454. doi: 10.3389/fonc.2022.907454. eCollection 2022.

CONTEXT

To improve the prognosis of variant histology (VH) bladder cancers, clinicians have used neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC) on the basis of radical cystectomy (RC). Despite some new data, the evidence remains mixed on their efficacy.

OBJECTIVE

To update the current evidence on the role of NAC and AC for VH bladder cancers.

EVIDENCE ACQUISITION

We searched for all studies investigating NAC or AC for bladder cancer patients with variant histology in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to December 2021. The primary end points were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).

EVIDENCE SYNTHESIS

We identified 18 reports comprising a total of 10,192 patients in the NAC studies. In patients with VH, the use of NAC did improve CSS (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55-0.99, p = 0.044), and OS (HR 0.74, 95% CI 0.66-0.84, p = 0.000), but not RFS (HR 1.15, 95% CI 0.56-2.33, p = 0.706). Subgroup analyses demonstrated that receiving NAC was associated with better OS in sarcomatoid VH (HR 0.67, 95% CI 0.54-0.83, p = 0.000) and neuroendocrine VH (HR 0.54, 95% CI 0.43-0.68, p = 0.000). For AC, we identified eight reports comprising a total of 3254 patients. There was a benefit in CSS (HR 0.61, 95% CI 0.43-0.87, p = 0.006) and OS (HR 0.76, 95% CI 0.60-0.98, p = 0.032). Subgroup analyses demonstrated that only neuroendocrine VH had better CSS (HR 0.29, 95% CI 0.13-0.67, p = 0.174) when receiving AC.

CONCLUSIONS

NAC or AC for VH bladder cancers confers an OS and CSS benefit compared with RC alone. For NAC, the benefit was independently observed in the sarcomatoid and neuroendocrine subgroups. As for AC, only neuroendocrine subgroups improved CSS.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42021289487.

背景

为改善变异组织学（VH）膀胱癌的预后，临床医生在根治性膀胱切除术（RC）的基础上采用了新辅助化疗（NAC）或辅助化疗（AC）。尽管有一些新数据，但关于它们疗效的证据仍然不一。

目的

更新关于NAC和AC在VH膀胱癌中作用的现有证据。

证据获取

我们在PubMed、Embase和Cochrane对照试验中央注册库中检索了截至2021年12月所有研究NAC或AC用于变异组织学膀胱癌患者的研究。主要终点是无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）。

证据综合

我们在NAC研究中确定了18篇报告，共纳入10192例患者。在VH患者中，使用NAC确实改善了CSS（风险比[HR]0.74，95%置信区间[CI]0.55 - 0.99，p = 0.044）和OS（HR 0.74，95% CI 0.66 - 0.84, p = 0.000），但未改善RFS（HR 1.15，95% CI 0.56 - 2.33，p = 0.706）。亚组分析表明，在肉瘤样VH（HR 0.67，95% CI 0.54 - 0.83，p = 0.000）和神经内分泌VH（HR 0.54，95% CI 0.43 - 0.68，p = 0.000）中，接受NAC与更好的OS相关。对于AC，我们确定了8篇报告，共纳入3254例患者。在CSS（HR 0.61，95% CI 0.43 - 0.87，p = 0.006）和OS（HR 0.76，95% CI 0.60 - 0.98，p = 0.032）方面有获益。亚组分析表明，接受AC时，只有神经内分泌VH有更好的CSS（HR 0.29，95% CI 0.13 - 0.67，p = 0.174）。