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Meta-Analysis
. 2022 May 19;17(5):e0267934.
doi: 10.1371/journal.pone.0267934. eCollection 2022.

Oncologic outcomes of Bacillus Calmette-Guérin therapy in elderly patients with non-muscle-invasive bladder cancer: A meta-analysis

Seyed Mohammad Kazem Aghamir  1 , Fatemeh Khatami  1 , Hossein Farrokhpour  2 , Leonardo Oliveira Reis  3 , Mahin Ahmadi Pishkuhi  4 , Abdolreza Mohammadi  1
Affiliations
Meta-Analysis

Oncologic outcomes of Bacillus Calmette-Guérin therapy in elderly patients with non-muscle-invasive bladder cancer: A meta-analysis

Seyed Mohammad Kazem Aghamir et al. PLoS One. .

Abstract

Introduction: There is a challenge on the medical efficacy of intravesical Bacillus Calmette-Guérin (BCG) therapy and the power of the immune system boosting, which can be influenced by the age of the non-muscle-invasive bladder cancer (NMIBC) patients. This meta-analysis evaluates the efficacy of BCG therapy among aged (>70) and younger patients with non-muscle-invasive bladder cancer (NMIBC).

Methods: The central database of PubMed, Scopus, and Web of Science were queried until August 4, 2021, by using "BCG," "Bladder Cancer," "AGE," and "efficacy" keywords. After excluding duplicated results, titles and abstracts were evaluated by two independent reviewers. The exclusion criteria included non-English studies, conference abstracts, reviews, editorials, letters, and comments. Three main outcomes, disease-free survival (DFS), progression-free survival (PFS), and cancer-specific survival (CSS), were considered. The statistical analysis was performed using STATA (version 14; Stata Corp, College Station, Texas, USA).

Results: From 1115 found documents, the 24 research articles were recruited in the systematic review, and 10 were the candidate for meta-analysis. The overall estimate of H.R. revealed that BCG therapy in those over age 70 is significantly associated with an improved risk of progression and cancer-specific death in studied patients. However, this association was not statistically significant for DFS (1.04 (95% CI: 0.85,1.26)).

Conclusion: The BCG maintenance therapy improved CSS and PFS oncological outcomes in elderly patients with NMIBC. BCG therapy did not significantly change the DSF.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection for the current meta-analysis.
Fig 2
Fig 2. The geographical distribution of studies.
Fig 3
Fig 3. Meta-analysis of the estimated hazard ratios (H.R.s) attributed to age, adjusting for other factors.
a: Overall HR of disease-free survival for eight studies (1.08). b: Overall HR of progression-free survival for 8 studies (1.22). c: Overall HR of cancer-specific survival for six studies (1.43).
Fig 4
Fig 4. Galbraith plot for indicating the sources of heterogeneity among meta-analysis results.
Fig 5
Fig 5. The funnel plot for publication bias evaluation.
Fig 6
Fig 6
(A) Begg’s funnel plot with pseudo 95% confidence limits. (B): Egger’s publication bias plot.
Fig 7
Fig 7. Publication bias for two missing studies.
See this image and copyright information in PMC

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