Chemoresection by mitomycin C compared to transurethral resection of bladder tumor in patients with recurrent nonmuscle-invasive bladder cancer: A systematic review and meta-analysis

Some studies suggest that chemoresection with mitomycin C (MMC) is comparable to transurethral resection of bladder tumor (TURBT) in the management of recurrent nonmuscle-invasive bladder cancer (NMIBC). In this meta-analysis, we compared the efficacy and safety of MMC and TURBT in recurrent NMIBC. A search was conducted for studies published in English in the electronic databases of MEDLINE/PubMed, the Cochrane Library, Scopus, Web of Science, Google Scholar, ProQuest, System for information on Grey Literature, and ClinicalTrials.gov, with no publication date restrictions. Risk of bias was assessed using the Risk of bias 2 tool for randomized controlled trials and Risk of Bias inNon-Randomized Studies of Interventions-I tool for observational studies. Data analysis was performed using the RevMan 5.4 software. Three studies were included in this systematic review(total participants is 291); two studieswere included in themeta-analysis. The rate of complete response was significantly lower in MMC group compared with TURBT (relative risk [RR]: 0.55, 95% confidence interval (CI): 0.45-0.67, P< .001). The rates of local adverse events were lower inMMC, with a statistical significance for dysuria (RR: 0.55, 95% CI: 0.36-0.84, P ¼ .006), urinary frequency (RR: 0.60, 95% CI: 0.43- 0.84, P¼ .003), cystitis (RR: 0.22, 95% CI: 0.06-0.81, P¼ .02), and incontinence (RR: 0.48, 95% CI: 0.24-0.96, P¼ .04). In terms of complete response, TURBT is superior to chemoresection withMMC. Currently, chemoresection withMMC should be restricted to patients unfit for surgery and in clinical trials. Future randomized controlled trials are recommended to confirm or refute the use ofMMC in treating recurrent NMIBC.