背景:膀胱内治疗的消融效果已经知道了几十年。然而,化学消融术治疗非肌层浸润性膀胱癌(NMIBC)的临床可行性和疗效尚未被接受.
目的:评估NMIBC化学消融术的治疗结果,并比较其与标准治疗的安全性,经尿道膀胱肿瘤切除术(TURBT),然后进行膀胱内治疗。
方法:在2022年7月查询了多个数据库,以调查使用丝裂霉素C(MMC)进行化学消融治疗的NMIBC患者的完全缓解(CR)率和不良事件,吉西他滨,表柔比星,或者卡介苗.
结果:总体而言,包含1199名患者的23项研究符合这项荟萃分析的条件。在这些研究中,20评估了化学消融的疗效,3比较了MMC化学消融与标准治疗的治疗结果。在每周服用任何药物的患者中,初始评估时,标记性病变的合并CR率为50.9%(95%置信区间[CI]:45.9-55.9),精心选择的NMIBC为47.5%(95%CI:36.5-58.7)(即,小肿瘤和/或少量肿瘤)。新的化学消融方案,如MMC凝胶(70.6%,95%CI:60.1-79.3)和强化MMC方案(64.7%,95%CI:56.2-72.3)在精心选择的NMIBC患者中提供了更好的CR率。与肿瘤多重性无关,观察到相当的CR率,而肿瘤大小<5mm的CR率高于肿瘤大小≥5mm的CR率(比值比:0.36,95%CI:0.17~0.79).新的强化MMC方案导致排尿困难和尿频率低于标准治疗。
结论:尽管缺乏长期结果,对于精心选择的NMIBC患者,化学消融似乎是一种有希望的治疗选择,并且可能有助于避免不必要的TURBT,特别是在一些中危NMIBC的老年患者中。需要进一步精心设计的更大队列的研究来解决这种复苏方法的差异耐受性和长期抗癌功效。
结果:膀胱滴注疗法对精心选择的非肌肉浸润性膀胱癌具有潜在的消融作用。这可能导致省略不必要的手术治疗。
BACKGROUND: The ablative effect of intravesical therapy is known for decades. However, the clinical feasibility and efficacy of
chemoablation for non-muscle-invasive bladder cancer (NMIBC) have not become accepted.
OBJECTIVE: To assess the treatment outcomes of
chemoablation for NMIBC and to compare its safety with that of the standard treatment, transurethral resection of bladder tumors (TURBT) followed by intravesical therapy.
METHODS: Multiple databases were queried in July 2022 for studies investigating the complete response (CR) rates and adverse events in NMIBC patients treated with chemoablation using mitomycin C (MMC), gemcitabine, epirubicin, or bacillus Calmette-Guérin.
RESULTS: Overall, 23 studies comprising 1199 patients were eligible for this meta-analysis. Among these studies, 20 assessed the efficacy of
chemoablation and three compared the treatment outcomes of MMC
chemoablation versus standard treatment. Among patients treated with weekly administration of any agent, the pooled CR rates at initial assessment were 50.9% (95% confidence interval [CI]: 45.9-55.9) for the marker lesion and 47.5% (95% CI: 36.5-58.7) for well-selected NMIBC (ie, small tumors and/or a small number of tumors). Novel regimens for
chemoablation such as MMC-gel (70.6%, 95% CI: 60.1-79.3) and an intensive MMC regimen (64.7%, 95% CI: 56.2-72.3) provided better CR rates in well-selected NMIBC patients. Comparable CR rates were noted irrespective of tumor multiplicity, whereas tumor size <5 mm was associated with a higher CR rate than tumor size ≥5 mm (odds ratio: 0.36, 95% CI: 0.17-0.79). The novel intensive MMC regimen resulted in lower rates of dysuria and urinary frequency than standard treatment.
CONCLUSIONS: Despite the lack of long-term outcomes, chemoablation appears to be a promising treatment option for well-selected NMIBC patients and can potentially help avoid unnecessary TURBT, specifically in some elderly patients with intermediate-risk NMIBC. Further well-designed studies with larger cohorts are necessary to address the differential tolerability and long-term anticancer efficacy of this resurging approach.
RESULTS: Bladder instillation therapy has a potential ablative effect for well-selected non-muscle-invasive bladder cancer. This can lead to the omission of an unnecessary surgical treatment.