Bladder preservation approach versus radical cystectomy for high-grade non-muscle-invasive bladder cancer: a meta-analysis of cohort studies

Abstract

BackgroundHigh-grade non-muscle-invasive bladder cancer is superficial; nonetheless, it is an aggressive cancer. Proper management strategy selection following transurethral resection between bladder preservation (BP) and radical cystectomy (RC) could result in delayed or excessive treatment. Hence, selecting the optimal treatment modality remains controversial to date.MethodsWe searched MEDLINE, The Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang database through 12 April 2018. Quality and publication bias were assessed using the Newcastle-Ottawa Scale and Begg’s/Egger’s test. We collected 2-year, 5-year, 10-year, and 15-year survival rate and hazard ratio (HR) for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Using the Review Manager 5.2 software, we used the odds ratio (OR) of specific years and HR for meta-analysis. Subgroup analysis was performed by the original tumor state, radical cystectomy timing, bladder preservation modality, and age.ResultsIn total, 11 cohorts with 1735 patients were selected for the meta-analysis. All OR of OS supported BP as a better treatment option; however, all OR of PFS had no significant differences. As for CSS, only the 15-year OR reflected a statistical significance preferring RC. Subgroup analysis showed that BP is more appropriate for patients older than 65 and G3 tumor. Limited data demonstrated that late RC (> 3 months) is more effective compared to early RC (< 3 months) and intravesical Bacillus Calmette–Guerin was not statistically different from that of RC. The mixed BP modalities were significantly better compared to RC in OS and worse in CSS, with both having a very low evidence strength.ConclusionsBP is a superior treatment modality compare to RC, especially for older patients and T1G3 or lower grade tumors. However, the superior BP modality was unclear. Conversely, RC could be a better option for younger patients. More specifically, late RC may be more beneficial but had a very-low-level of evidence. Quality of life should be considered equal to survival outcome; hence, post-treatment follow-up needs to be performed. Prospective randomized studies should be performed to overcome the limitations of this meta-analysis study.RegistrationRegistration ID is CRD42018093491.

Electro-mediated drug administration of mitomycin C in preventing non-muscle-invasive bladder cancer recurrence and progression after transurethral resection of the bladder tumour in intermediate- and high-risk patients

“…Non-muscle invasive bladder cancer (NMIBC) affects 70-80% of patients with bladder cancer (BC) [1][2][3]. NMIBC is the most common BC type, and a heterogeneous disease, characterised by a high risk of recurrence and a significant risk of progression to muscle-invasive disease after diagnosis.…”

Outcomes and complications of Hyperthermic IntraVesical Chemotherapy using Mitomycin-C or Epirubicin for patients with non-muscle invasive bladder cancer after Bacillus Calmette-Guérin treatment failure

“…Patients who desire bladder preservation or are unfit for radical surgery, can benefit from several bladder sparing strategies. These options include intravesical immunotherapy, chemotherapy or combined chemo-immunotherapy, device-assisted therapy or gene therapy [ 3 ]. Limited data and low-level evidence (LE) studies (LE:3) are available and all these techniques seem to be inferior in terms of bladder cancer specific mortality [ 2 ].…”

Serial Assessment of Circulating T lymphocyte Phenotype and Receptor Repertoire During Treatment of Non-Muscle Invasive Bladder Cancer with Adoptive T Cell Immunotherapy

“…Non-muscle-invasive transitional cell bladder cancer (NMIBC), accounting for more than 60% of bladder cancers [1], has a high recurrence rate (50% for high grade T1 disease [2]) after transurethral resection (TURBT), despite intravesical chemotherapy or immunotherapy with bacillus Calmette-Guerin (BCG) [3]. Immune checkpoint inhibitors have demonstrated e cacy in metastatic bladder cancers and preliminary data from a study of checkpoint blockade prior to cystectomy for muscle invasive bladder cancer has demonstrated a complete response rate of 39% [4] and studies for non-muscle invasive bladder cancer unresponsive to BCG are ongoing [5].…”