Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis
Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis
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浸润性膀胱癌的新辅助化疗：系统评价和荟萃分析
DOI：
10.1016/s0140-6736(03)13580-5
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
C. Vale
中科院分区：
文献类型：
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作者：
C. Vale
背景尽管对 3000 多名患者进行了随机对照试验，但新辅助化疗是否可以提高浸润性膀胱癌患者的生存率仍存在争议。我们进行了系统回顾和荟萃分析，以评估此类治疗对该疾病患者生存的影响。方法我们分析了来自 10 项可用随机试验的 2688 名个体患者的最新数据。结果以铂类为基础的联合化疗显示出对总体生存的显着益处（组合风险比 [HR] 0·87 [95% CI 0·78–0·98，p=0·016]；死亡风险降低 13%；绝对风险降低 5%） 5 年获益 [1-7]；总生存率从 45% 提高到 50%）。无论局部治疗的类型如何，都会观察到这种效应，并且在患者亚组之间没有差异。所有试验（包括使用单药顺铂的试验）的 HR 均倾向于新辅助化疗（HR=0·91，95% CI 0·83–1·01），尽管这种趋势并不显着（p=0·084）。尽管以铂类为基础的联合化疗是有益的，但没有证据支持使用单药铂类药物；事实上，这些试验组之间的效果存在显着差异（p=0·044）。解释这种生存率的改善鼓励对浸润性膀胱癌患者使用铂类联合化疗。
BackgroundControversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease.MethodsWe analysed updated data for 2688 individual patients from ten available randomised trials.FindingsPlatinum-based combination chemotherapy showed a significant benefit to overall survival (combined hazard ratio [HR] 0·87 [95% CI 0·78–0·98, p=0·016]; 13% reduction in risk of death; 5% absolute benefit at 5 years [1–7]; overall survival increased from 45% to 50%). This effect was observed irrespective of the type of local treatment, and did not vary between subgroups of patients. The HR for all trials, including those using single-agent cisplatin, tended to favour neoadjuvant chemotherapy (HR=0·91, 95% CI 0·83–1·01) although this tendency was not significant (p=0·084). Although platinum based combination chemotherapy was beneficial, there was no evidence to support the use of single-agent platinum; indeed, there was a significant difference in the effect between these groups of trials (p=0·044).InterpretationThis improvement in survival encourages the use of platinum-based combination chemotherapy for patients with invasive bladder cancer.