重复经尿道切除术在非肌层浸润性膀胱肿瘤中的作用：一项伞状综述
Role of repeat transurethral resection in no-muscle-invasive bladder tumour: an umbrella review.
作者信息
Yu Qing-Xin, Wu Rui-Cheng, Tuo Zhou-Ting, Zhu Wei-Zhen, Wang Jie, Ye Xing, Yoo Koo Han, Wei Wu-Ran, Feng De-Chao, Li Deng-Xiong
机构信息
Department of Pathology, Ningbo Clinical Pathology Diagnosis Center, Ning 685 East Section of Huancheng North Road, Ningbo City, Zhejiang Province 315211, China.
Department of Pathology, Ningbo Medical Centre Lihuili Hospital, Ningbo City, Zhejiang Province, 315040, China.
出版信息
Ther Adv Med Oncol. 2024 Nov 16;16:17588359241298470. doi: 10.1177/17588359241298470. eCollection 2024.
BACKGROUND
Repeat transurethral resection of bladder tumour (reTURB) is a conventional treatment for non-muscle-invasive bladder cancer (NMIBC) to enhance prognosis. However, the necessity of reTURB in NMIBC remains controversial owing to upstaging of treatments and new evidence.
OBJECTIVES
We performed an umbrella review to determine the need for reTURB in patients with NMIBC.
DESIGN
We extracted data from meta-analyses that were screened out after a systematic search of PubMed, Embase, the Web of Science and the Cochrane Database of Systematic Reviews.
METHODS
Risk of Bias in Systematic Reviews and the Grading of Recommendations, Assessment, Development and Evaluation tools were used to assess the quality of each included meta-analysis and outcomes.
RESULTS
Our study included seven meta-analyses. Two studies assessed the efficiency of reTURB in patients who underwent en bloc resection of bladder tumours (ERBT). Patients who underwent ERBT reported low residual tumour and upstaging rates of 5.9% and 0.3%, respectively. Conversely, patients who underwent conventional transurethral resection for bladder cancer (cTURB) had high residual tumour rates. Patients who underwent cTURB and reTURB had significantly improved 1-year recurrence-free survival (RFS) compared to those who underwent initial cTURB alone. In terms of progression-free survival (PFS), a meta-analysis reported that patients who underwent cTURB and reTURB had significantly improved PFS compared with those who underwent initial cTURB alone. In the subgroup analyses of ERBT, reTURB did not affect the RFS and PFS of patients who received ERBT. Currently, only a limited number of randomised clinical trials have evaluated reTURB, and various factors have influenced its efficacy.
CONCLUSION
There was significant variation in survival outcomes among patients undergoing reTURB. The necessity and efficacy of reTURB depend on numerous factors, such as surgical approach, equipment and medication usage. Patients eligible for ERBT may constitute a group that does not require reTURB. Further clinical trials are required to validate these findings.
REGISTRATION
This umbrella review was registered with the International Prospective Register of Systematic Reviews (CRD42023439078).
背景
重复经尿道膀胱肿瘤切除术（reTURB）是一种用于非肌层浸润性膀胱癌（NMIBC）以改善预后的传统治疗方法。然而，由于治疗分期的改变和新证据的出现，NMIBC中reTURB的必要性仍存在争议。
目的
我们进行了一项伞状综述，以确定NMIBC患者是否需要进行reTURB。
设计
我们从对PubMed、Embase、科学网和Cochrane系统评价数据库进行系统检索后筛选出的荟萃分析中提取数据。
方法
使用系统评价中的偏倚风险以及推荐意见分级、评估、制定与评价工具来评估每项纳入的荟萃分析和结果的质量。
结果
我们的研究纳入了七项荟萃分析。两项研究评估了接受膀胱肿瘤整块切除术（ERBT）的患者中reTURB的疗效。接受ERBT的患者报告的残余肿瘤率和分期升级率分别为5.9%和0.3%，较低。相反，接受传统经尿道膀胱癌切除术（cTURB）的患者残余肿瘤率较高。与仅接受初次cTURB的患者相比，接受cTURB和reTURB的患者1年无复发生存率（RFS）有显著改善。在无进展生存期（PFS）方面，一项荟萃分析报告称，与仅接受初次cTURB的患者相比，接受cTURB和reTURB的患者PFS有显著改善。在ERBT的亚组分析中，reTURB不影响接受ERBT患者的RFS和PFS。目前，仅有有限数量的随机临床试验评估了reTURB，且多种因素影响了其疗效。
结论
接受reTURB的患者生存结局存在显著差异。reTURB的必要性和疗效取决于多种因素，如手术方式、设备和药物使用情况。符合ERBT条件的患者可能是不需要reTURB的群体。需要进一步的临床试验来验证这些发现。
注册情况
本伞状综述已在国际前瞻性系统评价注册库（CRD42023439078）注册。
Zotero 插件