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Optimal schedule of bacillus calmette-guerin for non-muscle-invasive bladder cancer: a meta-analysis of comparative studies.

Zhu S, Tang Y, Li K, Shang Z, Jiang N, Nian X, Sun L, Niu Y - BMC Cancer (2013)

Bottom Line: BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events.Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity.Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Tianjin Institute of Urology, 2nd Hospital of Tianjin Medical University, Pingjiang Road 23, Tianjin, People's Republic of China.

ABSTRACT

Background: To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).

Methods: Comprehensive searches of electronic databases (PubMed, Embase, and the Cochrane Library) were performed, then a systematic review and cumulative meta-analysis of 21 randomized controlled trials (RCTs) and 9 retrospective comparative studies were carried out according to predefined inclusion criteria.

Results: Significantly better recurrence-free survivals (RFS) were observed respectively in patients who received BCG maintenance, standard-dose and BCG plus epirubicin therapy comparing to those received induction, low-dose and BCG alone. BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events. Pooled results showed no remarkable advantage of BCG combined with Mitomycin C or with interferon α-2b in improving oncologic outcomes. Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity. Our data confirmed that non-RCT only affected strength rather than direction of the overall results.

Conclusions: All patients with superficial BCa should be encouraged to accept BCG maintenance therapy with standard-dose if well tolerated. Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.

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Forest plots of pooled results (A, recurrence-free survival; B, progression-free survival) for the BCG plus Epirubicin group and BCG alone group.
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Figure 6: Forest plots of pooled results (A, recurrence-free survival; B, progression-free survival) for the BCG plus Epirubicin group and BCG alone group.

Mentions: Evidence from 3 studies [38-40] showed that combination of BCG and epirubicin could significantly prevent or delay the recurrence of superficial BCa (HR=0.618; 95% CI 0.384-0.993; P=0.047) (Figure 6A). The combination therapy had a more significant effect on preventing high-risk NMIBC from recurrence (HR=0.544; 95% CI 0.302-0.980; P=0.043). Progression rate was reported in 2 studies including 202 high-risk NMIBC patients [38,40], better outcome was observed in patients received combined therapy of BCG plus epirubicin, but this difference was not statistically significant (HR=0.513; 95% CI 0.132-1.987; P=0.334) (Figure 6B). The homogeneity among included studies was recognized by heterogeneity test (Table 4).


Optimal schedule of bacillus calmette-guerin for non-muscle-invasive bladder cancer: a meta-analysis of comparative studies.

Zhu S, Tang Y, Li K, Shang Z, Jiang N, Nian X, Sun L, Niu Y - BMC Cancer (2013)

Forest plots of pooled results (A, recurrence-free survival; B, progression-free survival) for the BCG plus Epirubicin group and BCG alone group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3722001&req=5

Figure 6: Forest plots of pooled results (A, recurrence-free survival; B, progression-free survival) for the BCG plus Epirubicin group and BCG alone group.
Mentions: Evidence from 3 studies [38-40] showed that combination of BCG and epirubicin could significantly prevent or delay the recurrence of superficial BCa (HR=0.618; 95% CI 0.384-0.993; P=0.047) (Figure 6A). The combination therapy had a more significant effect on preventing high-risk NMIBC from recurrence (HR=0.544; 95% CI 0.302-0.980; P=0.043). Progression rate was reported in 2 studies including 202 high-risk NMIBC patients [38,40], better outcome was observed in patients received combined therapy of BCG plus epirubicin, but this difference was not statistically significant (HR=0.513; 95% CI 0.132-1.987; P=0.334) (Figure 6B). The homogeneity among included studies was recognized by heterogeneity test (Table 4).

Bottom Line: BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events.Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity.Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Tianjin Institute of Urology, 2nd Hospital of Tianjin Medical University, Pingjiang Road 23, Tianjin, People's Republic of China.

ABSTRACT

Background: To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).

Methods: Comprehensive searches of electronic databases (PubMed, Embase, and the Cochrane Library) were performed, then a systematic review and cumulative meta-analysis of 21 randomized controlled trials (RCTs) and 9 retrospective comparative studies were carried out according to predefined inclusion criteria.

Results: Significantly better recurrence-free survivals (RFS) were observed respectively in patients who received BCG maintenance, standard-dose and BCG plus epirubicin therapy comparing to those received induction, low-dose and BCG alone. BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events. Pooled results showed no remarkable advantage of BCG combined with Mitomycin C or with interferon α-2b in improving oncologic outcomes. Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity. Our data confirmed that non-RCT only affected strength rather than direction of the overall results.

Conclusions: All patients with superficial BCa should be encouraged to accept BCG maintenance therapy with standard-dose if well tolerated. Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.

Show MeSH
Related in: MedlinePlus