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Review
. 2023 Dec 7:10:1276746.
doi: 10.3389/fsurg.2023.1276746. eCollection 2023.

Comparing trimodal therapy with radical cystectomy in muscle-invasive bladder cancer: an updated meta-analysis

Ahmad R Al-Qudimat  1   2 , Kalpana Singh  3 , Laxmi K Ojha  1 , Diala Alhaj Moustafa  1 , Mai Elaarag  1 , Raed M Al-Zoubi  1   4   5 , Omar M Aboumarzouk  1   6
Affiliations
Review

Comparing trimodal therapy with radical cystectomy in muscle-invasive bladder cancer: an updated meta-analysis

Ahmad R Al-Qudimat et al. Front Surg. .

Abstract

Background: We conducted this meta-analysis to compare the two muscle-invasive bladder cancer (MIBC) treatment modalities in terms of cancer-specific survival (CSS) and other outcome indicators.

Method: A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. The search was conducted using various academic databases including Scopus, PubMed, Cochrane database, EMBASE, Chinese biomedical literature database, Wan fang databases, and China National Knowledge Internet databases between 1966 and December 2023. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) No. (CRD42023398977).

Result: This study included a total of 54,816 patients diagnosed with bladder cancer from 14 studies, of which 6,228 patients were assigned to the trimodal therapy (TMT) group and 48,588 patients were assigned to the radical cystectomy (RC) group. Based on the results, the RC group exhibited a higher rate of survival than the TMT group [pooled hazard ratio (HR) = 1.23, 95% CI: 1.18-1.28, Z = 1.46, P < 0.001]. In terms of CSS, patients in the RC group had a longer CSS compared with those in the TMT group (pooled HR = 1.47, 95% CI: 1.29-1.67, Z = 5.893, P < 0.001). Compared with RC, TMT is significantly associated with an increased risk of both types of mortality (pooled HR: 1.30, P < 0.001).

Conclusion: Overall, the findings of this meta-analysis suggest that RC treatment may be associated with improved overall survival. Moreover, it was observed that cancer-specific survival was significantly prolonged among patients in the RC group as opposed to those who received TMT. In addition, it was shown that patients who received TMT exhibited a higher risk of all-cause mortality when compared with those who underwent RC.

Keywords: bladder preserving; cancer; muscle-invasive; radical cystectomy; trimodal.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA diagram of literature search.
Figure 2
Figure 2
(A) Traffic light plot of risk of bias assessment (non-randomized studies), (B) Cochrane tool, and (C) risk of bias across studies Cochrane tool.
Figure 3
Figure 3
Forest plot comparing clinical T stage and eastern cooperative oncology group (ECOG) in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC). (A) T stage <2 for RCT, (B) T stage <2 for retrospective studies, (C) T stage ≥2 for RCT, (D) T stage ≥2 for retrospective studies, (E) ECOG ≥1, and (F) ECOG = 0.
Figure 3
Figure 3
Forest plot comparing clinical T stage and eastern cooperative oncology group (ECOG) in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC). (A) T stage <2 for RCT, (B) T stage <2 for retrospective studies, (C) T stage ≥2 for RCT, (D) T stage ≥2 for retrospective studies, (E) ECOG ≥1, and (F) ECOG = 0.
Figure 4
Figure 4
Forest plot comparing cancer grade and Charlson comorbidity score (CCS) in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC). (A) Cancer grade others, (B) cancer grade for UC, (C) CCS ≥2, (D) CCS = 0, and (E) CCS = 1.
Figure 4
Figure 4
Forest plot comparing cancer grade and Charlson comorbidity score (CCS) in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC). (A) Cancer grade others, (B) cancer grade for UC, (C) CCS ≥2, (D) CCS = 0, and (E) CCS = 1.
Figure 5
Figure 5
Forest plot comparing (A) cancer-specific survival (B) overall survival in RCTs in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC).
See this image and copyright information in PMC

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