Impact of intravesical chemotherapy on recurrence rate of recurrent superficial transitional cell carcinoma of the bladder: Results of a meta-analysis

Background: The impact of in travesical chemotherapy on preventing recurren ce of superficial transitional cell carcinoma of the bladder is controversi al The objective of this report is to present a meta-analysis of the availa ble clinical trial data to quantify the effect of intravesical chemotherapy on tumor recurrence following trans-urethral resection (TURB) in patients with recurrent superficial bladder cancer. Methods: A prospective study pro tocol outlining a meta-analysis was developed followed by a thorough search of the existing published literature using strict eligibility criteria. Ei ght randomized trials were found which met protocol specifications. These s tudies contained data on 1,609 patients which were statistically combined u sing a fired effects model (Peto). The outcome of interest was the proporti on of patients with tumor recurrence at one, two and three years post-TURB. Results: Combining all 8 studies using 1 year recurrence as the outcome me asure yielded a Peto odds ratio (ORp) of 0.62 demonstrating a 38% reduction in one year recurrence among patients treated with intravesical chemothera py versus TURB alone. Using 2 and 3 year recurrence as the outcome measure yielded ORp's of 0.46 and 0.35 respectively, favoring TURB + intravesical c hemotherapy versus TURB alone. A statistical test for heterogeneity (Q) sho wed the 2 and 3 year outcome data to be heterogeneous (i.e. the studies ale not measuring an effect of the same magnitude). Sensitivity analyses showe d that drug type appeared to account for the observed heterogeneity with a stratified analysis demonstrating that adriamycin is less effective in redu cing subsequent tumor recurrences than all other drugs studied. Conclusion: Intravesical chemotherapy appeals to have a major impact on decreasing the chance of recurrence of recurrent superficial bladder cancer. Three year r ecurrence is decreased by as much as 70% when compared with TURB alone. The se data are in contrast to prior analyses suggesting only modest efficacy o f such treatment in this clinical setting.