Trimodal therapy vs radical cystectomy in patients with muscle-invasive bladder cancer: a systematic review and meta-analysis of comparative studies.

Autor: Ditonno F; Department of Urology, Rush University Medical Center, Chicago, IL, USA.; Department of Urology, University of Verona, Verona, Italy., Veccia A; Department of Urology, University of Verona, Verona, Italy., Montanaro F; Department of Urology, University of Verona, Verona, Italy., Pettenuzzo G; Department of Urology, University of Verona, Verona, Italy., Franco A; Department of Urology, Rush University Medical Center, Chicago, IL, USA.; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy., Manfredi C; Department of Urology, Rush University Medical Center, Chicago, IL, USA.; Urology Unit, Department of Woman, Child and General and Specialized Surgery, 'Luigi Vanvitelli' University, Naples, Italy., Triggiani L; Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy., De Nunzio C; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy., De Sio M; Urology Unit, Department of Woman, Child and General and Specialized Surgery, 'Luigi Vanvitelli' University, Naples, Italy., Cerruto M; Department of Urology, University of Verona, Verona, Italy., Crivellaro S; Department of Urology, University of Illinois at Chicago, Chicago, IL, USA., Kutikov A; Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Autorino R; Department of Urology, Rush University Medical Center, Chicago, IL, USA., Antonelli A; Department of Urology, University of Verona, Verona, Italy.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Nov; Vol. 134 (5), pp. 684-695. Date of Electronic Publication: 2024 Apr 15.
DOI: 10.1111/bju.16366
Abstrakt: Objective: To perform a systematic review and meta-analysis of trials comparing trimodal therapy (TMT) and radical cystectomy (RC), evaluating differences in terms of oncological outcomes, quality of life, and costs.
Materials and Methods: In July 2023, a literature search of multiple databases was conducted to identify studies analysing patients with cT2-4 N any M0 muscle-invasive bladder cancer (MIBC; Patients) receiving TMT (Intervention) compared to RC (Comparison), to evaluate survival outcomes, recurrence rates, costs, and quality of life (Outcomes). The primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS) and metastasis-free survival (MFS). Hazard ratios (HRs) were used to analyse survival outcomes according to different treatment modalities and odds ratios were used to evaluate the likelihood of receiving each type of treatment according to T stage.
Results: No significant difference in terms of OS was observed between RC and TMT (HR 1.07, 95% confidence interval [CI] 0.81-1.4; P = 0.6), even when analysing radiation therapy regimens ≥60 Gy (HR 1.02, 95% CI 0.69-1.52; P = 0.9). No significant difference was observed in CSS (HR 1.12, 95% CI 0.79-1.57, P = 0.5) or MFS (HR 0.88, 95% CI 0.66-1.16; P = 0.3). The mean cost of TMT was significantly higher than that of RC ($289 142 vs $148 757; P < 0.001), with greater effectiveness in terms of cost per quality-adjusted life-year. TMT ensured significantly higher general quality-of-life scores.
Conclusion: Trimodal therapy appeared to yield comparable oncological outcomes to RC concerning OS, CSS and MFS, while providing superior patient quality of life and cost effectiveness.
(© 2024 BJU International.)
Databáze: MEDLINE
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