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. 2016 Jul 19;7(29):45479-45488.
doi: 10.18632/oncotarget.9991.

Single, immediate postoperative instillation of chemotherapy in non-muscle invasive bladder cancer: a systematic review and network meta-analysis of randomized clinical trials using different drugs

Minyong Kang  1 , Chang Wook Jeong  1 , Cheol Kwak  1 , Hyeon Hoe Kim  1 , Ja Hyeon Ku  1
Affiliations

Single, immediate postoperative instillation of chemotherapy in non-muscle invasive bladder cancer: a systematic review and network meta-analysis of randomized clinical trials using different drugs

Minyong Kang et al. Oncotarget. .

Abstract

We performed a network meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of several intravesical chemotherapeutic (IVC) agents after transurethral resection of bladder tumor (TURB) in non-muscle invasive bladder cancer patients. The literature search was conducted using the Embase, Scopus and PubMed databases for RCTs, including patients with single or multiple, primary or recurrent stage Ta or T1 urothelial carcinoma of the bladder managed with a single, immediate instillation of IVC after TURB. Thirteen RCTs met the eligibility criteria. Pair-wise meta-analysis (direct comparison) showed that pirarubicin [hazard ratio (HR): 0.31], epirubicin (HR: 0.62), and MMC (HR: 0.40) were the most effective drugs for reducing tumor recurrence. Bayesian network meta-analysis (indirect comparison) revealed that treatment with pirarubicin (HR: 0.31), MMC (HR: 0.44), or epirubicin (HR: 0.60) was associated with prolonged recurrence-free survival. Among the drugs examined, only pirarubicin reduced disease progression compared to controls. These results suggest that a single, immediate administration of IVC with pirarubicin, MMC, or epirubicin is associated with prolonged recurrence-free survival following TURB in non-muscle invasive bladder cancer patients, though only pirarubicin also reduced disease progression.

Keywords: chemotherapy; drug therapy; single instillation; systematic review; urinary bladder neoplasm.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA statement flow diagram illustrating the search strategy used for the network meta-analysis
Figure 2
Figure 2. Network geometry of clinical trials of a single, immediate postoperative instillation of chemotherapy for recurrence-free survival in non-muscle invasive bladder cancer
Lines represent direct comparison trials.
Figure 3
Figure 3. Direct comparisons of efficacy between each pair of chemotherapy treatments
The horizontal lines correspond to the study-specific hazard ratio and 95% confidence interval. The area of the squares reflects the study-specific weight. The diamond represents the results for pooled hazard ratio and 95% confidence interval. (A) Pirarubicin. (B) Epirubicin. (C) Gemcitabine. (D) Mitomycin (C) (E) Thiotepa.
Figure 4
Figure 4. Pooled hazard ratio and 95% credible intervals for recurrence-free survival
Figure 5
Figure 5. Ranking of treatments in terms of recurrence-free survival benefit
Each treatment was ranked using percentages from 2,000 iterations.
See this image and copyright information in PMC

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