A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer
This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (BC) with or without neoadjuvant chemotherapy (NAC). A systematic search was conducted according to the PRISMA guid...
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| Veröffentlicht in: | Urologic oncology 2018-02, Vol.36 (2), p.43-53 |
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| creator | Fahmy, Omar Khairul-Asri, Mohd Ghani Schubert, Tina Renninger, Markus Malek, Rohan Kübler, Hubert Stenzl, Arnulf Gakis, Georgios |
| description | This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (BC) with or without neoadjuvant chemotherapy (NAC).
A systematic search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. A total of 57 studies including 30,293 patients were included. The 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC were assessed.
The mean 10-year OS was 30.9% for TMT and 35.1% for RC (P = 0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P = 0.26). NAC was administered before therapy to 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P |
| doi_str_mv | 10.1016/j.urolonc.2017.10.002 |
| format | Article |
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A systematic search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. A total of 57 studies including 30,293 patients were included. The 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC were assessed.
The mean 10-year OS was 30.9% for TMT and 35.1% for RC (P = 0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P = 0.26). NAC was administered before therapy to 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P<0.001). Complete response (CR) was achieved in 1,545 (75.3%) of 2,051 evaluable patients treated with TMT. A 5-year OS, DSS, and RFS after CR were 66.9%, 78.3%, and 52.5%, respectively. Downstaging after transurethral bladder tumor resection or NAC to stage ≤pT1 at RC was reported in 2,416 (29.1%) of 8,311 patients. NAC significantly increased the rate of pT0 from 20.2% to 34.3% (P = 0.007) in cT2 and from 3.8% to 23.9% (P<0.001) in cT3–4. A 5-year OS, DSS, and RFS in downstaged patients (≤pT1) at RC were 75.7%, 88.3%, and 75.8%, respectively.
In this analysis, the survival outcomes of patients after TMT and RC for MIBC were comparable. Patients who experienced downstaging after NAC and RC exhibited improved survival compared to patients treated with RC only. Best survival outcomes after TMT are associated with CR to this approach.
•This is a comprehensive comparison of oncological outcomes of both modalities.•The survival outcomes of patients after TMT and RC for MIBC were comparable.•Downstaging after NAC and RC exhibited improved survival compared to RC only.•Best survival outcomes after TMT are associated with complete response.</description><identifier>ISSN: 1078-1439</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2017.10.002</identifier><identifier>PMID: 29102254</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bladder cancer ; Radical cystectomy ; Trimodal therapy</subject><ispartof>Urologic oncology, 2018-02, Vol.36 (2), p.43-53</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-4cc97e8d20343ff938e341b3fb695b50800b31c022d3643652c4a0de6d5e46353</citedby><cites>FETCH-LOGICAL-c365t-4cc97e8d20343ff938e341b3fb695b50800b31c022d3643652c4a0de6d5e46353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S107814391730529X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29102254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fahmy, Omar</creatorcontrib><creatorcontrib>Khairul-Asri, Mohd Ghani</creatorcontrib><creatorcontrib>Schubert, Tina</creatorcontrib><creatorcontrib>Renninger, Markus</creatorcontrib><creatorcontrib>Malek, Rohan</creatorcontrib><creatorcontrib>Kübler, Hubert</creatorcontrib><creatorcontrib>Stenzl, Arnulf</creatorcontrib><creatorcontrib>Gakis, Georgios</creatorcontrib><title>A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (BC) with or without neoadjuvant chemotherapy (NAC).
A systematic search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. A total of 57 studies including 30,293 patients were included. The 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC were assessed.
The mean 10-year OS was 30.9% for TMT and 35.1% for RC (P = 0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P = 0.26). NAC was administered before therapy to 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P<0.001). Complete response (CR) was achieved in 1,545 (75.3%) of 2,051 evaluable patients treated with TMT. A 5-year OS, DSS, and RFS after CR were 66.9%, 78.3%, and 52.5%, respectively. Downstaging after transurethral bladder tumor resection or NAC to stage ≤pT1 at RC was reported in 2,416 (29.1%) of 8,311 patients. NAC significantly increased the rate of pT0 from 20.2% to 34.3% (P = 0.007) in cT2 and from 3.8% to 23.9% (P<0.001) in cT3–4. A 5-year OS, DSS, and RFS in downstaged patients (≤pT1) at RC were 75.7%, 88.3%, and 75.8%, respectively.
In this analysis, the survival outcomes of patients after TMT and RC for MIBC were comparable. Patients who experienced downstaging after NAC and RC exhibited improved survival compared to patients treated with RC only. Best survival outcomes after TMT are associated with CR to this approach.
•This is a comprehensive comparison of oncological outcomes of both modalities.•The survival outcomes of patients after TMT and RC for MIBC were comparable.•Downstaging after NAC and RC exhibited improved survival compared to RC only.•Best survival outcomes after TMT are associated with complete response.</description><subject>Bladder cancer</subject><subject>Radical cystectomy</subject><subject>Trimodal therapy</subject><issn>1078-1439</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFUctu1DAUjRCIlsIngLxkk8GOnUyyQlVVHlIlNrC2buybjkdxPNjOVPlDPoubmSlbVte-Og_7nKJ4L_hGcNF82m_mGMYwmU3FxZZ2G86rF8W1aLeyrFTXvKQz37alULK7Kt6ktOdcqFaI18VV1QleVbW6Lv7csrSkjB6yMyzi0eETg8kyjxlKmGBckkssTCzvkIYhz0dnYGTk_VhmjJ6FOZvgMTEY6M5ydD5YGF1eVlKEw3JSjGBPRLP6mRz8wp5c3rEQT5NU2IQB7H4-wpSZ2aEPz_yBQH5OZsTSTUdI7oisH8Fa8jMwGYxvi1cDjAnfXeZN8evL_c-7b-XDj6_f724fSiObOpfKmG6Lra24VHIYOtmiVKKXQ990dV_zlvNeCkPpWNkoolRGAbfY2BpVI2t5U3w86x5i-D1jytq7ZHAcgR4_Jy26RnBZq60gaH2GmhhSijjoA0UDcdGC67VEvdeXEvVa4rqmEon34WIx9x7tP9ZzawT4fAYgfZQaizoZh5SCdZGS1Ta4_1j8BZA9tos</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Fahmy, Omar</creator><creator>Khairul-Asri, Mohd Ghani</creator><creator>Schubert, Tina</creator><creator>Renninger, Markus</creator><creator>Malek, Rohan</creator><creator>Kübler, Hubert</creator><creator>Stenzl, Arnulf</creator><creator>Gakis, Georgios</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201802</creationdate><title>A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer</title><author>Fahmy, Omar ; Khairul-Asri, Mohd Ghani ; Schubert, Tina ; Renninger, Markus ; Malek, Rohan ; Kübler, Hubert ; Stenzl, Arnulf ; Gakis, Georgios</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-4cc97e8d20343ff938e341b3fb695b50800b31c022d3643652c4a0de6d5e46353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Bladder cancer</topic><topic>Radical cystectomy</topic><topic>Trimodal therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fahmy, Omar</creatorcontrib><creatorcontrib>Khairul-Asri, Mohd Ghani</creatorcontrib><creatorcontrib>Schubert, Tina</creatorcontrib><creatorcontrib>Renninger, Markus</creatorcontrib><creatorcontrib>Malek, Rohan</creatorcontrib><creatorcontrib>Kübler, Hubert</creatorcontrib><creatorcontrib>Stenzl, Arnulf</creatorcontrib><creatorcontrib>Gakis, Georgios</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fahmy, Omar</au><au>Khairul-Asri, Mohd Ghani</au><au>Schubert, Tina</au><au>Renninger, Markus</au><au>Malek, Rohan</au><au>Kübler, Hubert</au><au>Stenzl, Arnulf</au><au>Gakis, Georgios</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2018-02</date><risdate>2018</risdate><volume>36</volume><issue>2</issue><spage>43</spage><epage>53</epage><pages>43-53</pages><issn>1078-1439</issn><eissn>1873-2496</eissn><abstract>This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (BC) with or without neoadjuvant chemotherapy (NAC).
A systematic search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. A total of 57 studies including 30,293 patients were included. The 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC were assessed.
The mean 10-year OS was 30.9% for TMT and 35.1% for RC (P = 0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P = 0.26). NAC was administered before therapy to 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P<0.001). Complete response (CR) was achieved in 1,545 (75.3%) of 2,051 evaluable patients treated with TMT. A 5-year OS, DSS, and RFS after CR were 66.9%, 78.3%, and 52.5%, respectively. Downstaging after transurethral bladder tumor resection or NAC to stage ≤pT1 at RC was reported in 2,416 (29.1%) of 8,311 patients. NAC significantly increased the rate of pT0 from 20.2% to 34.3% (P = 0.007) in cT2 and from 3.8% to 23.9% (P<0.001) in cT3–4. A 5-year OS, DSS, and RFS in downstaged patients (≤pT1) at RC were 75.7%, 88.3%, and 75.8%, respectively.
In this analysis, the survival outcomes of patients after TMT and RC for MIBC were comparable. Patients who experienced downstaging after NAC and RC exhibited improved survival compared to patients treated with RC only. Best survival outcomes after TMT are associated with CR to this approach.
•This is a comprehensive comparison of oncological outcomes of both modalities.•The survival outcomes of patients after TMT and RC for MIBC were comparable.•Downstaging after NAC and RC exhibited improved survival compared to RC only.•Best survival outcomes after TMT are associated with complete response.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29102254</pmid><doi>10.1016/j.urolonc.2017.10.002</doi><tpages>11</tpages></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | Bladder cancer Radical cystectomy Trimodal therapy |
| title | A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer |
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