Matloubieh Jubin E, Hanelin David, Agalliu Ilir
Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Cancers (Basel). 2024 Dec 10;16(24):4125. doi: 10.3390/cancers16244125.
Non-muscle-invasive bladder cancer (NMIBC) comprises about 75% of all bladder cancers. Although NMIBC is treatable, it poses significant costs and burdens to patients due to high recurrence rates. We conducted an updated meta-analysis of studies that evaluated the efficacy of and outcomes after treatment with mitomycin C (MMC), gemcitabine (GEM), and docetaxel (DOCE) for NMIBC recurrence and progression. We searched the PubMed and Cochrane databases for observational cohort studies and randomized clinical trials (RCT) conducted between 2009 and 2022 that assessed the efficacy of GEM, DOCE, or MMC, alone or in combination, regarding NMIBC outcomes. A total of 49 studies that met the inclusion criteria were reviewed for their quality, sample size, outcomes, and potential for bias, and relevant data were extracted for the meta-analysis. Separate meta-analyses were performed to assess the risks of recurrence or progression when comparing GEM/DOCE or MMC vs. other treatments. Study heterogeneity was assessed by I statistics. Among 31 studies comparing GEM or MMC to other treatments for NMIBC recurrence, there were statistically significant risk reductions of 24% for GEM (pooled relative risk (RR) of 0.76; 95% confidence interval (CI) 0.64-0.87) and 37% for MMC (pooled RR = 0.63; 95% CI 0.58-0.68). Recurrence-free survival (RFS) for GEM or MMC alone was 69.5% (95% CI 66.6-72.3%) and 67.2% (95% CI 66.2-68.2%), respectively. Studies assessing the combination of treatments had a pooled RFS of 44.6% (95% CI 40.4-48.7%). Fewer studies examined the risk of NMIBC progression, with large variability and inconclusive results across them. Our findings corroborate recent guidelines indicating that both GEM and MMC are effective treatments that reduce tumor recurrence and improve survival of NMIBC, although with large variability across the studies. Fewer studies evaluated DOCE treatment, with inconclusive results. Women and minorities were generally underrepresented, raising concerns about the generalizability of the findings and highlighting the importance of including a broader patient population in future RCTs.
非肌层浸润性膀胱癌（NMIBC）约占所有膀胱癌的75%。尽管NMIBC是可治疗的，但由于高复发率，它给患者带来了巨大的成本和负担。我们对评估丝裂霉素C（MMC）、吉西他滨（GEM）和多西他赛（DOCE）治疗NMIBC复发和进展的疗效及结果的研究进行了更新的荟萃分析。我们在PubMed和Cochrane数据库中搜索了2009年至2022年期间进行的观察性队列研究和随机临床试验（RCT），这些研究评估了GEM、DOCE或MMC单独或联合使用对NMIBC结果的疗效。对总共49项符合纳入标准的研究进行了质量、样本量、结果和偏倚可能性的审查，并提取了相关数据进行荟萃分析。在比较GEM/DOCE或MMC与其他治疗方法时，进行了单独的荟萃分析以评估复发或进展的风险。通过I统计量评估研究异质性。在31项比较GEM或MMC与其他治疗方法治疗NMIBC复发的研究中，GEM的复发风险显著降低了24%（合并相对风险（RR）为0.76；95%置信区间（CI）为0.64 - 0.87），MMC降低了37%（合并RR = 0.63；95%CI为0.58 - 0.68）。单独使用GEM或MMC的无复发生存率（RFS）分别为69.5%（95%CI为66.6 - 72.3%）和67.2%（95%CI为66.2 - 68.2%）。评估联合治疗的研究的合并RFS为44.6%（95%CI为40.4 - 48.7%）。较少的研究考察了NMIBC进展的风险，各研究结果差异很大且尚无定论。我们的研究结果证实了最近的指南，即GEM和MMC都是有效的治疗方法，可降低肿瘤复发并提高NMIBC患者的生存率，尽管各研究结果差异很大。评估DOCE治疗的研究较少，结果尚无定论。女性和少数族裔在研究中普遍代表性不足，这引发了对研究结果可推广性的担忧，并凸显了在未来的RCT中纳入更广泛患者群体的重要性。
