A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: A meta-analysis of published results of randomized clinical trials
A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: A meta-analysis of published results of randomized clinical trials
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DOI：
10.1097/01.ju.0000125486.92260.b2
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发表时间：
2004-06-01
影响因子：
6.6
通讯作者：
van der Meijden, APM
中科院分区：
文献类型：
--
作者：
Sylvester, RJ;Oosterlinck, W;van der Meijden, APM
目的：探讨Ta-T1期膀胱癌患者经尿道电切(TUR)后1次即刻化疗是否能降低复发风险。材料与方法：对已发表的比较TUR与TUR加1次化疗的随机临床试验结果进行荟萃分析。结果：我们的研究纳入了7项随机试验。根据中位3.4年和最长14.5年的随访期，接受表阿霉素、丝裂霉素C、硫代替巴或(2“R)-4‘-O-四氢吡喃-阿霉素(吡柔比星)滴注的728例患者中有267例(36.7%)复发，而单纯TUR748例中有362例(48.4%)复发，与化疗相比，复发几率降低了39%(OR0.61，p<；0.0001)。单发肿瘤患者(OR 0.61)和多发肿瘤患者(OR 0.44)受益。结论：Ta T1期单发和多发膀胱癌患者TUR术后1次化疗复发率明显低于单发膀胱癌患者。它是单一低风险乳头状肿瘤患者的首选治疗方法，建议将其作为高危肿瘤患者TUR后的初始治疗。
Purpose: We determined if 1 immediate instillation of chemotherapy after transurethral resection (TUR) decreases the risk of recurrence in patients with stage Ta T1 single and multiple bladder cancer overall and separately.Materials and Methods: A meta-analysis was performed of the published results of randomized clinical trials comparing TUR alone to TUR plus 1 immediate instillation of chemotherapy.Results: Our study included 7 randomized trials with recurrence information on 1,476 patients. Based on a median followup of 3.4 years and a maximum of 14.5 years, 267 of 728 patients (36.7%) receiving 1 postoperative instillation of epirubicin, mitomycin C, thiotepa or (2"R)-4'-O-tetrahydropyranyl-doxorubicin (pirarubicin) had recurrence compared to 362 of 748 patients (48.4%) with TUR alone, a decrease of 39% in the odds of recurrence with chemotherapy (OR 0.61, p < 0.0001). Patients with a single tumor (OR 0.61) and those with multiple tumors (OR 0.44) benefited. However, after 1 instillation 65.2% of patients with multiple tumors had recurrence compared to 35.8% of patients with single tumors, showing that 1 instillation alone is insufficient treatment for patients with multiple tumors.Conclusions: One immediate intravesical instillation of chemotherapy significantly decreases the risk of recurrence after TUR in patients with stage Ta T1 single and multiple bladder cancer. It is the treatment of choice in patients with a single, low risk papillary tumor and is recommended as the initial treatment after TUR in patients with higher risk tumors.