M. Huncharek et al., Impact of intravesical chemotherapy on recurrence rate of recurrent superficial transitional cell carcinoma of the bladder: Results of a meta-analysis, ANTICANC R, 21(1B), 2001, pp. 765-769
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.