背景:围手术期全身治疗在肌层浸润性膀胱癌的综合治疗中起着至关重要的作用。虽然新辅助铂类化疗已被证明有效,在有多种合并症的患者中,给予辅助化疗可能具有挑战性。尽管免疫疗法在转移环境中显示出成功,其在新辅助和辅助治疗中的有效性仍在研究中.本研究旨在进行系统的文献综述和荟萃分析,以评估化疗和/或免疫治疗在新辅助和/或辅助环境中的影响。
方法:通过咨询PubMed,Scopus,以及1994年至2023年期间的ClinicalTrial.gov数据库。该分析利用森林图来研究关键兴趣点:新辅助化疗(NAC)的总生存期/病理反应和辅助化疗(AC)的总生存期/无病生存期。采用随机或固定模型。
结果:系统综述包括26篇文章,14例纳入荟萃分析.对于NAC,五项研究评估了总体生存率,产生的总体风险比(HR)为0.84[0.75-0.94];p=0.002。在五项研究中评估了NAC下的病理反应,导致总比值比(OR)为0.3[0.2-0.4];与膀胱切除术和0.86[0.65-1.13]相比,p<0.001;MVAC与GC.关于AC,六项研究调查了总体生存率,显示总体HR为0.93[0.77-1.12];p=0.46。在七项研究中检查了AC下的无病生存率,总OR为0.58[0.44-0.78];p<0.001。由于新辅助设置中的II期研究有限,并且在辅助设置中只有两项可用的研究,因此未对免疫治疗进行荟萃分析。
结论:本研究重申了铂类化疗在新辅助和辅助方案中的疗效。提高肌层浸润性膀胱癌患者的总生存率。免疫疗法在新辅助治疗中的肿瘤降级和无病生存中显示出有希望的结果。在佐剂设置中。
BACKGROUND: Perioperative systemic treatments play a crucial role in the comprehensive management of muscle-invasive bladder cancer. While neoadjuvant platinum-based chemotherapy has a proven efficacy, administering adjuvant chemotherapy can be challenging in patients with multiple comorbidities. Although immunotherapy has shown success in metastatic settings, its effectiveness in both neoadjuvant and adjuvant settings remains under investigation. This study aims to conduct a systematic literature
review and meta-analysis to assess the impact of chemotherapy and/or immunotherapy in neoadjuvant and/or adjuvant settings.
METHODS: A systematic
review and meta-analysis were conducted by consulting the PubMed, Scopus, and ClinicalTrial.gov databases for the period from 1994 to 2023. The analysis utilized Forest Plots for key points of interest: overall survival/pathologic response for neoadjuvant chemotherapy (NAC) and overall survival/disease-free survival for adjuvant chemotherapy (AC), employing random or fixed models.
RESULTS: The systematic
review included 26 articles, and 14 were incorporated into the meta-analysis. For NAC, five studies assessed overall survival, yielding an overall hazard ratio (HR) of 0.84 [0.75-0.94]; P=0.002. Pathologic response under NAC was evaluated in five studies, resulting in an overall odds ratio (OR) of 0.3 [0.2-0.4]; P<0.001 compared to cystectomy and 0.86 [0.65-1.13]; P=0.28 for MVAC vs. GC. Regarding AC, six studies investigated overall survival, revealing an overall HR of 0.93 [0.77-1.12]; P=0.46. Disease-free survival under AC was examined in seven studies, with an overall OR of 0.58 [0.44-0.78]; P<0.001. Meta-analysis was not conducted for immunotherapy due to limited phase II studies in the neoadjuvant setting and only two available studies in the adjuvant setting.
CONCLUSIONS: This study reaffirms the efficacy of platinum-based chemotherapy in neoadjuvant and adjuvant scenarios, enhancing overall survival in muscle-invasive bladder cancer patients. Immunotherapy exhibits promising outcomes in tumor downstaging in the neoadjuvant setting and in disease-free survival, in the adjuvant setting.