Matsukawa Akihiro, Yanagisawa Takafumi, Miszczyk Marcin, Kardoust Parizi Mehdi, Fazekas Tamás, Tsuboi Ichiro, Mancon Stefano, Klemm Jakob, Schulz Robert, Cadenar Anna, Laukhtina Ekaterina, Rajwa Paweł, Mori Keiichiro, Miki Jun, Kimura Takahiro, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland.
Eur Urol Focus. 2024 Nov 21. doi: 10.1016/j.euf.2024.11.003.
Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). It is highly invasive and associated with perioperative risks, while bladder-preserving trimodality therapy (TMT) offers a less invasive alternative with preferable quality of life for selected patients. We aimed to compare oncological outcomes of TMT and RC in MIBC patients, and evaluate TMT-specific outcomes.
In December 2023, PubMed, Scopus, and Web of Science were searched for studies on MIBC patients treated with TMT. Pairwise meta-analyses were conducted to compare overall survival (OS) and cancer-specific survival (CSS) between MIBC patients treated with TMT and RC, utilizing hazard ratios (HRs). We included only matched cohort studies to minimize selection bias. TMT-specific outcomes, such as response, recurrence, and toxicity rates, were pooled separately.
Eighty-seven studies (n = 28 218) were identified. No significant differences in OS (HR: 1.05; 95% confidence interval [CI]: 0.78-1.40) and CSS (HR: 1.05; 95% CI: 0.69-1.58) were found for TMT compared with RC. In patients treated with TMT, the complete response was achieved in 74.4% (95% CI: 69.1-79.1), the estimated rate of intravesical recurrence was 23.1% (95% CI: 19.0-27.7), and the rate of grade ≥3 acute toxicity was 11.4% (95% CI: 4.0-28.4).
The oncological outcomes of TMT were comparable with those of RC, with an acceptable toxicity profile. TMT appears as a safe and effective treatment for appropriately selected MIBC patients who want to preserve their bladder. However, evidence from high-volume controlled trials is needed.
Well-selected patients with nonmetastatic muscle-invasive bladder cancer can be treated with "trimodality therapy" to preserve the bladder. So far, the reported outcomes are comparable with those of radical surgery, and we found no signs of excess toxicity.
根治性膀胱切除术（RC）是肌层浸润性膀胱癌（MIBC）的标准治疗方法。该手术具有高度侵入性且伴有围手术期风险，而保膀胱三联疗法（TMT）为部分患者提供了侵入性较小且生活质量更佳的替代方案。我们旨在比较MIBC患者接受TMT和RC后的肿瘤学结局，并评估TMT特有的结局。
2023年12月，检索了PubMed、Scopus和Web of Science数据库中关于接受TMT治疗的MIBC患者的研究。采用危险比（HR）进行成对荟萃分析，比较接受TMT和RC治疗的MIBC患者的总生存期（OS）和癌症特异性生存期（CSS）。我们仅纳入匹配队列研究以尽量减少选择偏倚。分别汇总TMT特有的结局，如缓解率、复发率和毒性率。
共识别出87项研究（n = 28218）。与RC相比，TMT在OS（HR：1.05；95%置信区间[CI]：0.78 - 1.40）和CSS（HR：1.05；95% CI：0.69 - 1.58）方面无显著差异。接受TMT治疗的患者中，完全缓解率为74.4%（95% CI：69.1 - 79.1），膀胱内复发估计率为23.1%（95% CI：19.0 - 27.7），≥3级急性毒性率为11.4%（95% CI：4.0 - 28.4）。
TMT的肿瘤学结局与RC相当，毒性特征可接受。对于希望保留膀胱的合适MIBC患者，TMT似乎是一种安全有效的治疗方法。然而，仍需要来自大规模对照试验的证据。
精心挑选的非转移性肌层浸润性膀胱癌患者可采用“三联疗法”保留膀胱。到目前为止，报告的结局与根治性手术相当，且我们未发现过度毒性的迹象。
