Department of Urology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
Department of Urology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
Fr J Urol. 2024 Sep;34(9):102704. doi: 10.1016/j.fjurol.2024.102704. Epub 2024 Jul 24.
Perioperative systemic treatments play a crucial role in the comprehensive management of muscle-invasive bladder cancer. While neoadjuvant platinum-based chemotherapy has a proven efficacy, administering adjuvant chemotherapy can be challenging in patients with multiple comorbidities. Although immunotherapy has shown success in metastatic settings, its effectiveness in both neoadjuvant and adjuvant settings remains under investigation. This study aims to conduct a systematic literature review and meta-analysis to assess the impact of chemotherapy and/or immunotherapy in neoadjuvant and/or adjuvant settings.
A systematic review and meta-analysis were conducted by consulting the PubMed, Scopus, and ClinicalTrial.gov databases for the period from 1994 to 2023. The analysis utilized Forest Plots for key points of interest: overall survival/pathologic response for neoadjuvant chemotherapy (NAC) and overall survival/disease-free survival for adjuvant chemotherapy (AC), employing random or fixed models.
The systematic review included 26 articles, and 14 were incorporated into the meta-analysis. For NAC, five studies assessed overall survival, yielding an overall hazard ratio (HR) of 0.84 [0.75-0.94]; P=0.002. Pathologic response under NAC was evaluated in five studies, resulting in an overall odds ratio (OR) of 0.3 [0.2-0.4]; P<0.001 compared to cystectomy and 0.86 [0.65-1.13]; P=0.28 for MVAC vs. GC. Regarding AC, six studies investigated overall survival, revealing an overall HR of 0.93 [0.77-1.12]; P=0.46. Disease-free survival under AC was examined in seven studies, with an overall OR of 0.58 [0.44-0.78]; P<0.001. Meta-analysis was not conducted for immunotherapy due to limited phase II studies in the neoadjuvant setting and only two available studies in the adjuvant setting.
This study reaffirms the efficacy of platinum-based chemotherapy in neoadjuvant and adjuvant scenarios, enhancing overall survival in muscle-invasive bladder cancer patients. Immunotherapy exhibits promising outcomes in tumor downstaging in the neoadjuvant setting and in disease-free survival, in the adjuvant setting.
围手术期全身治疗在肌层浸润性膀胱癌的综合治疗中起着至关重要的作用。新辅助铂类化疗已被证实具有疗效，但在合并多种合并症的患者中，辅助化疗的实施具有挑战性。虽然免疫疗法在转移性疾病中取得了成功，但它在新辅助和辅助治疗中的有效性仍在研究中。本研究旨在进行系统的文献复习和荟萃分析，以评估化疗和/或免疫疗法在新辅助和/或辅助治疗中的作用。
通过检索 PubMed、Scopus 和 ClinicalTrials.gov 数据库，对 1994 年至 2023 年期间的文献进行了系统综述和荟萃分析。使用森林图分析了新辅助化疗（NAC）的总生存率/病理反应和辅助化疗（AC）的总生存率/无病生存率等关键指标，采用随机或固定模型。
系统综述共纳入 26 篇文章，其中 14 篇纳入荟萃分析。对于 NAC，五项研究评估了总生存率，总风险比（HR）为 0.84[0.75-0.94]；P=0.002。五项研究评估了 NAC 下的病理反应，总优势比（OR）为 0.3[0.2-0.4]；与根治性膀胱切除术相比，P<0.001；与 MVAC 相比，OR 为 0.86[0.65-1.13]；P=0.28。对于 AC，六项研究评估了总生存率，总 HR 为 0.93[0.77-1.12]；P=0.46。七项研究评估了 AC 下的无病生存率，总 OR 为 0.58[0.44-0.78]；P<0.001。由于新辅助治疗中仅有有限的 II 期研究，辅助治疗中仅有两项可用研究，因此未对免疫疗法进行荟萃分析。
本研究再次证实了铂类化疗在新辅助和辅助治疗中的疗效，提高了肌层浸润性膀胱癌患者的总生存率。免疫疗法在新辅助治疗中显示出肿瘤降期和辅助治疗中无病生存率的良好效果。
