■总结动脉内化疗(IAC)对高危非肌层浸润性膀胱癌(NMIBC)影响的当前证据,并比较肿瘤学结果与膀胱内化疗(IVC)。
■我们在2021年2月通过对多个科学数据库的系统搜索,对感兴趣的主要结果进行了系统评价和累积荟萃分析。分别计算连续变量和二分变量的平均差(MD)和比值比(OR),95%置信区间(CI)。具有95%CIs的危险无线电(HR)用于总生存期(OS),无复发生存期(RFS)和无进展生存期(PFS)。
■共纳入6项研究,共866名患者。IAC联合IVC与单独IVC相比,肿瘤复发率差异有统计学意义(OR:0.51,95%CI[0.36~0.72],p=0.0001),肿瘤进展率(OR:0.47,95%CI[0.30~0.72],p=0.0006),肿瘤特异性死亡率(OR:0.49,95%CI[0.25~0.99],p=0.05),PFS(HR:0.47,95%CI[0.23~0.96],p=0.04)和RFS(HR:0.60,95%CI[0.41~0.87],p=0.007)。两组首次复发时间无显著差异(MD:3.27,95%CI[-2.37~8.92],p=0.26)和OS(HR:1.20,95%CI[0.44~3.32],p=0.72)。对于单独的IAC和IVC,肿瘤特异性死亡率无统计学差异(OR:0.67,95%CI[0.29~1.53],p=0.34),RFS(HR:0.90,95%CI[0.56~1.46],p=0.68)和PFS(HR:0.71,95%CI[0.32~1.55],p=0.39)。不良事件主要包括恶心/呕吐(36.3%),低白血病(19.4%),中性粒细胞减少症(16.0%),肌酐升高(9.9%),丙氨酸转氨酶增加(18.7%),和血小板减少(9.9%)。
■IAC联合IVC是高风险NMIBC的安全有效治疗方法,复发率较低,programming,肿瘤特异性死亡,PFS和RFS,以及轻微和可容忍的事件。单独IAC的有效性与单独IVC平行。
UNASSIGNED: To summarize the current evidence on the effects of intra-arterial chemotherapy (IAC) on high-risk non-muscle invasive bladder cancer (NMIBC) and compare oncology results with intravesical chemotherapy (IVC).
UNASSIGNED: We performed a systematic
review and cumulative meta-analysis of the primary outcomes of interest by a systematical search of multiple scientific databases in February 2021. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous variables respectively, with 95% confidence intervals (CIs). The hazard radio (HR) with 95% CIs was used for overall survival (OS), recurrence-free survival (RFS) and progression-free survival (PFS).
UNASSIGNED: A total of six studies with 866 patients were included. For IAC combined with IVC versus IVC alone, statistically significant differences were found regarding tumor recurrence rate (OR: 0.51, 95% CI [0.36∼0.72], p = 0.0001), tumor progression rate (OR: 0.47, 95% CI [0.30∼0.72], p = 0.0006), tumor-specific death rate (OR: 0.49, 95% CI [0.25∼0.99], p = 0.05), PFS (HR: 0.47, 95% CI [0.23∼0.96], p = 0.04) and RFS (HR: 0.60, 95% CI [0.41∼0.87], p = 0.007). No significant difference between two groups was found for time to first recurrence (MD: 3.27, 95% CI [-2.37∼8.92], p = 0.26) and OS (HR: 1.20, 95% CI [0.44∼3.32], p = 0.72). For IAC alone versus IVC, There was no statistical difference in the terms of tumor-specific death rate (OR: 0.67, 95% CI [0.29∼1.53], p = 0.34), RFS (HR: 0.90, 95% CI [0.56∼1.46], p = 0.68) and PFS (HR: 0.71, 95% CI [0.32∼1.55], p = 0.39). Adverse events mainly included nausea/vomiting (36.3%), hypoleukemia (19.4%), neutropenia (16.0%), increased creatinine (9.9%), increased alanine aminotransferase (18.7%), and thrombocytopenia (9.9%).
UNASSIGNED: The IAC combined with IVC is a safe and effective treatment for high risk NMIBC, with lower rates of recurrence, progression, tumor-specific death, PFS and RFS, and with minor and tolerable events. The effectiveness of the IAC alone is parallel to the IVC alone.