115 research outputs found
Adjuvant Chemotherapy for Muscle-invasive Bladder Cancer : A Systematic Review and Meta-analysis of Individual Participant Data from Randomised Controlled Trials
Context
Our prior systematic review and meta-analysis of individual participant data (IPD) suggesting a benefit of adjuvant chemotherapy for muscle-invasive bladder cancer was limited by the number and size of included randomised trials. We have updated results to include additional trials, providing the most up-to-date and reliable evidence of the effects of this treatment.
Objective
To investigate the role of adjuvant cisplatin-based chemotherapy in the treatment of muscle-invasive bladder cancer.
Evidence acquisition
Published and unpublished trials were sought via searches of bibliographic databases, trials registers, conference proceedings, and hand searching. Updated IPD were centrally collected, checked, and analysed. Results from individual randomised controlled trials (RCTs) were combined using a two-stage fixed-effect model. Prespecified analyses explored any variation in effect by trial and participant characteristics.
Evidence synthesis
Analyses of ten RCTs (1183 participants) demonstrated a benefit of cisplatin-based adjuvant chemotherapy on overall survival (hazard ratio [HR] = 0.82, 95% confidence interval [CI] = 0.70–0.96, p = 0.02). This represents an absolute improvement in survival of 6% at 5 yr, from 50% to 56%, and a 9% absolute benefit when adjusted for age, sex, pT stage, and pN category (HR = 0.77, 95% CI = 0.65–0.92, p = 0.004). There was no clear evidence that the effect varied by trial or participant characteristics. Adjuvant chemotherapy was also shown to improve recurrence-free survival (HR = 0.71, 95% CI = 0.60–0.83, p < 0.001), locoregional recurrence-free survival (HR = 0.68, 95% CI = 0.55–0.85, p < 0.001), and metastasis-free survival (HR = 0.79, 95% CI = 0.65–0.95, p = 0.01), with absolute benefits of 11%, 11%, and 8%, respectively.
Conclusions
This systematic review and meta-analysis demonstrates that cisplatin-based adjuvant chemotherapy is a valid option for improving outcomes for muscle-invasive bladder cancer.
Patient summary
We looked at the effect of cisplatin-based chemotherapy on outcomes in participants with muscle-invasive bladder cancer. We gathered this information from eligible randomised controlled trials. We demonstrated that cisplatin-based chemotherapy is a valid option for improving outcomes of muscle-invasive bladder cancer
Selection bias is not a good reason for advising more than 5 years of adjuvant hormonal therapy for all patients with locally advanced prostate cancer treated with radiotherapy
Reply to Magdi Mounir Kirollos' Letter to the Editor re: Urs E. Studer, Laurence Collette, Peter Whelan, et al. Using PSA to Guide Timing of Androgen Deprivation in Patients with T0-4 N0-2 M0 Prostate Cancer Not Suitable for Local Curative Treatment (EORTC 30891). Eur Urol 2008;53:941-9 and re: John Anderson. Androgen Deprivation Therapy-It's All a Matter of Timing. Eur Urol 2008;53:869-71
Re: Shahrokh F. Shariat, Behfar Ehdaie, Michael Rink, et al. Clinical nodal staging scores for bladder cancer: a proposal for preoperative risk assessment. Eur urol 2012;61:237-42
Selection Bias Is Not a Good Reason for Advising More Than 5 Years of Adjuvant Hormonal Therapy for All Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy
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