背景:目前非肌层浸润性膀胱癌的治疗效果欠佳。然而,近年来,热疗膀胱内化疗(HIVEC)已成为常规膀胱灌注的更有效替代方法.这种新颖的治疗方法似乎具有与卡介苗(BCG)灌注相似的治疗效果。本研究旨在评估HIVEC与常规膀胱灌注化疗治疗非肌层浸润性膀胱癌的安全性和有效性。此外,本研究旨在评估HIVEC与BCG灌注治疗非肌层浸润性膀胱癌的安全性和有效性.
方法:我们对PubMed进行了全面搜索,Embase,科克伦图书馆,和WebofScience数据库收集有关非肌肉浸润性膀胱癌HIVEC的相关研究。使用RevMan5.3软件对收集的数据进行分析。
结果:本荟萃分析共纳入8项随机对照试验,涉及1,203名患者。其中,629例接受HIVEC,419例接受丝裂霉素C常规膀胱灌注化疗,155例接受卡介苗治疗。联合分析显示,膀胱热灌注的复发率明显低于常规灌注化疗(RR=0.65,95%CI:0.52,0.82,p=0.0003)。然而,HIVEC和BCG灌注的复发率没有显着差异(RR=0.78,95%CI:0.56,1.09,p=0.14)。此外,HIVEC组与常规膀胱化疗组(RR=1.08,95%CI:0.52,2.26,p=0.83)和BCG灌注组(RR=0.48,95%CI:0.19,1.25,p=0.13)之间的进展率无显著差异.然而,与常规膀胱灌注化疗组相比,膀胱热疗化疗组和常规膀胱灌注化疗组的不良事件无显著统计学差异(RR1.08,95%CI:0.80,1.45,p=0.63).HIVEC和BCG灌注之间的不良事件发生率没有显着差异(RR1.03,95%CI:0.83,1.29,p=0.79)。
结论:现有结果表明,HIVEC,与常规膀胱灌注化疗相比,可以降低非肌层浸润性膀胱癌的复发率。然而,它不会显着影响进展率。使用HIVEC和常规化疗的不良事件发生率无统计学差异。此外,复发率没有显着差异,进展率,与卡介苗相比,不良事件的发生率。
BACKGROUND: The current treatment of non-muscle-invasive bladder cancer is suboptimal. However, in recent years, hyperthermia intravesical chemotherapy (HIVEC) has emerged as a more effective alternative to conventional bladder perfusion. This novel treatment approach appears to have a similar therapeutic effect as Bacillus Calmette-Guérin (BCG) perfusion. This study aims to evaluate the safety and effectiveness of HIVEC compared to conventional bladder perfusion chemotherapy for non-muscle-invasive bladder cancer. Additionally, it aims to evaluate the safety and effectiveness of HIVEC in comparison to BCG perfusion therapy for non-muscle-invasive bladder cancer.
METHODS: We conducted a comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases to gather relevant studies on HIVEC for non-muscle-invasive bladder cancer. The analysis of the collected data was carried out using RevMan 5.3 software.
RESULTS: A total of 8 randomized controlled trials were included in this meta-analysis, involving 1,203 patients. Among them, 629 cases received HIVEC, 419 cases received conventional bladder perfusion chemotherapy with mitomycin C, and 155 cases received BCG. The combined analysis revealed that the recurrence rate of bladder hyperthermic perfusion was significantly lower than that of conventional perfusion chemotherapy (RR = 0.65, 95% CI: 0.52, 0.82, p = 0.0003). However, there was no significant difference in recurrence rate between HIVEC and BCG perfusion (RR = 0.78, 95% CI: 0.56, 1.09, p = 0.14). Furthermore, no significant difference was found in the progression rate between the HIVEC group and either the conventional bladder chemotherapy group (RR = 1.08, 95% CI: 0.52, 2.26, p = 0.83) and the BCG perfusion group (RR = 0.48, 95% CI: 0.19, 1.25, p = 0.13). However, compared with the conventional bladder perfusion chemotherapy group, there was no significant statistical difference in adverse events between the bladder hyperthermia chemotherapy group and the conventional bladder perfusion chemotherapy group (RR 1.08, 95% CI: 0.80, 1.45, p = 0.63). No significant difference in the incidence of adverse events was observed between HIVEC and BCG perfusion (RR 1.03, 95% CI: 0.83, 1.29, p = 0.79).
CONCLUSIONS: The existing results indicate that HIVEC, when compared to conventional bladder perfusion chemotherapy, can lower the recurrence rate of non-muscle-invasive bladder cancer. However, it does not significantly affect the progression rate. There was no statistically significant difference observed in the incidence of adverse events between the use of HIVEC and conventional chemotherapy. Additionally, there was no significant difference in the recurrence rate, progression rate, and incidence of adverse events when compared to BCG.