Immediate post-TURBT intravesical chemotherapy prevents non-muscle-invasive bladder cancer recurrences: An updated meta-analysis on 2,548 patients and quality of evidence review
CUA Online Library. Perlis N. 06/25/13; 31317; MP-07.04
Disclosure(s): none to declare
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Abstract
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Introduction: Non-muscle-invasive bladder cancer (NMIBC) commonly recurs, requiring invasive and costly transurethral resection (TURBT). A meta-analysis published in 2004 demonstrated that intravesical (IVe) chemotherapy following TURBT reduces recurrences. Although recently updated clinical guidelines endorse this practice, its uptake has been modest.
Purpose: Our primary objectives were: 1) to investigate whether immediate post-operative IVe chemotherapy prolongs recurrence free interval (RFI) and early recurrences (ER) in light of new trial data and 2) to explore the quality of evidence supporting its use.
Methods: A systematic literature review of randomized controlled trials published before March 2013 was performed with Medline, Embase, and Cochrane databases. We included trials examining NMIBC recurrence for adults receiving IVe chemotherapy immediately following TURBT. RFI was estimated by hazard ratio (HR) and ER were estimated by absolute risk reduction (ARR) within one year of TURBT. Outcomes were synthesized using random-effects models. Quality of evidence for each outcome was evaluated using the GRADE approach.
Results: Thirteen articles were included with 2,548 patients represented. IVe chemotherapy prolonged RFI by 38% (HR 0.62, 95% CI: 0.50-0.77, p<0.0001) and ER were 12% less likely in the intervention population (ARR 0.12, 95% CI: -0.18 to -0.06, p<0.0001). There was high risk of bias present in 12/13 studies. Quality of evidence for RFI was “very low” and for ER was “low”.
Conclusions: IVe chemotherapy reduces RFI and ER of NMIBC when administered immediately after TURBT. Due to high-risk of bias and low evidence quality, well-designed RCTs addressing these questions are still warranted.
Purpose: Our primary objectives were: 1) to investigate whether immediate post-operative IVe chemotherapy prolongs recurrence free interval (RFI) and early recurrences (ER) in light of new trial data and 2) to explore the quality of evidence supporting its use.
Methods: A systematic literature review of randomized controlled trials published before March 2013 was performed with Medline, Embase, and Cochrane databases. We included trials examining NMIBC recurrence for adults receiving IVe chemotherapy immediately following TURBT. RFI was estimated by hazard ratio (HR) and ER were estimated by absolute risk reduction (ARR) within one year of TURBT. Outcomes were synthesized using random-effects models. Quality of evidence for each outcome was evaluated using the GRADE approach.
Results: Thirteen articles were included with 2,548 patients represented. IVe chemotherapy prolonged RFI by 38% (HR 0.62, 95% CI: 0.50-0.77, p<0.0001) and ER were 12% less likely in the intervention population (ARR 0.12, 95% CI: -0.18 to -0.06, p<0.0001). There was high risk of bias present in 12/13 studies. Quality of evidence for RFI was “very low” and for ER was “low”.
Conclusions: IVe chemotherapy reduces RFI and ER of NMIBC when administered immediately after TURBT. Due to high-risk of bias and low evidence quality, well-designed RCTs addressing these questions are still warranted.
Introduction: Non-muscle-invasive bladder cancer (NMIBC) commonly recurs, requiring invasive and costly transurethral resection (TURBT). A meta-analysis published in 2004 demonstrated that intravesical (IVe) chemotherapy following TURBT reduces recurrences. Although recently updated clinical guidelines endorse this practice, its uptake has been modest.
Purpose: Our primary objectives were: 1) to investigate whether immediate post-operative IVe chemotherapy prolongs recurrence free interval (RFI) and early recurrences (ER) in light of new trial data and 2) to explore the quality of evidence supporting its use.
Methods: A systematic literature review of randomized controlled trials published before March 2013 was performed with Medline, Embase, and Cochrane databases. We included trials examining NMIBC recurrence for adults receiving IVe chemotherapy immediately following TURBT. RFI was estimated by hazard ratio (HR) and ER were estimated by absolute risk reduction (ARR) within one year of TURBT. Outcomes were synthesized using random-effects models. Quality of evidence for each outcome was evaluated using the GRADE approach.
Results: Thirteen articles were included with 2,548 patients represented. IVe chemotherapy prolonged RFI by 38% (HR 0.62, 95% CI: 0.50-0.77, p<0.0001) and ER were 12% less likely in the intervention population (ARR 0.12, 95% CI: -0.18 to -0.06, p<0.0001). There was high risk of bias present in 12/13 studies. Quality of evidence for RFI was “very low” and for ER was “low”.
Conclusions: IVe chemotherapy reduces RFI and ER of NMIBC when administered immediately after TURBT. Due to high-risk of bias and low evidence quality, well-designed RCTs addressing these questions are still warranted.
Purpose: Our primary objectives were: 1) to investigate whether immediate post-operative IVe chemotherapy prolongs recurrence free interval (RFI) and early recurrences (ER) in light of new trial data and 2) to explore the quality of evidence supporting its use.
Methods: A systematic literature review of randomized controlled trials published before March 2013 was performed with Medline, Embase, and Cochrane databases. We included trials examining NMIBC recurrence for adults receiving IVe chemotherapy immediately following TURBT. RFI was estimated by hazard ratio (HR) and ER were estimated by absolute risk reduction (ARR) within one year of TURBT. Outcomes were synthesized using random-effects models. Quality of evidence for each outcome was evaluated using the GRADE approach.
Results: Thirteen articles were included with 2,548 patients represented. IVe chemotherapy prolonged RFI by 38% (HR 0.62, 95% CI: 0.50-0.77, p<0.0001) and ER were 12% less likely in the intervention population (ARR 0.12, 95% CI: -0.18 to -0.06, p<0.0001). There was high risk of bias present in 12/13 studies. Quality of evidence for RFI was “very low” and for ER was “low”.
Conclusions: IVe chemotherapy reduces RFI and ER of NMIBC when administered immediately after TURBT. Due to high-risk of bias and low evidence quality, well-designed RCTs addressing these questions are still warranted.
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