M. Huncharek et al., Intravesical chemotherapy prophylaxis in primary superficial bladder cancer: a meta-analysis of 3703 patients from 11 randomized trials, J CLIN EPID, 53(7), 2000, pp. 676-680
Citations number
18
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
The impact of intravesical chemotherapy prophylaxis on recurrence of superf
icial transitional cell carcinoma of the bladder is poorly defined. The obj
ective of this report is to present a meta-analysis of the available clinic
al trial data to quantify the effect of intravesical chemotherapy on tumor
recurrence following complete transurethral resection (TURB) in patients wi
th newly diagnosed superficial bladder cancer. A prospective protocol outli
ning the above meta-analysis was initially developed followed by a thorough
search of the existing published literature using strict eligibility crite
ria. Eleven randomized trials were found that met protocol specifications.
These studies contained data on 3703 patients that were statistically combi
ned using a fixed effects model (Peto). The outcome of interest was the pro
portion of patients recurring at 1, 2, and 3 years post-TURB. Combining all
11 studies using 1-year recurrence as the outcome measure yielded a Peto o
dds ratio (ORp) of 0.56, demonstrating a 44% reduction in 1-year recurrence
among patients treated with intravesical chemotherapy versus those treated
with TURB alone. A statistical test for heterogeneity (Q) showed these dat
a to be heterogenous (the studies are not measuring an effect of the same s
ize). Sensitivity analyses were performed to determine sources of heterogen
eity. These tests suggest that chemotherapy treatment schedule may account
for the wide variation in tumor recurrence rates across studies. When the a
vailable clinical trial data were stratified by duration of treatment, the
meta-analysis showed that intravesical chemotherapy decreased tumor recurre
nce from 30% to 80% depending on the outcome of interest (i.e., recurrence
at 1, 2, or 3 years post-TURB). Intravesical chemotherapy appears to have a
major impact on decreasing the chance of recurrence of superficial transit
ional cell carcinoma of the bladder. This is in contrast to prior analyses
suggesting only modest efficacy in this clinical setting (i.e,, on the orde
r of a 14% reduction in recurrence). (C) 2000 Elsevier Science Inc. All rig
hts reserved.