浸润性膀胱癌新辅助化疗随机对照试验的Meta分析

Neoadjuvant chemotherapy for muscle invasive transitional cell carcinoma of the bladder:a Meta-analysis of randomized controlled trials on mortality

目的评价新辅助化疗对肌层浸润性膀胱癌患者预后的疗效。方法系统检索Medline、Embase、Cochrane中的相关文献，检索1991年1月至2012年10月间发表的新辅助化疗有关的相关前瞻性随机对照研究，按预设的标准进行筛选。结果共12个研究符合纳入标准，总样本量3296例，新辅助治疗组1649例，对照组1647例，对纳入研究进行质量评价，并提取数据进行Meta分析。新辅助化疗组与对照组相比，死亡风险优势比OR0．85（95％CI0．73～0．98，P=0．03）。将12个纳入研究按新辅助化疗方案进行亚组分析，单用铂剂组显示新辅助化疗并没有降低患者死亡风险，而以铂剂为基础的多药联合新辅助化疗可降低患者死亡风险（OR 0．79，95％CI0．0．92，P=0．0004）。结论新辅助化疗，尤其是以铂剂为基础的联合化疗方案，适用于肌层浸润性膀胱癌的治疗，可改善预后。

Objective To assess the efficacy of neoadjuvant chemotherapy bladder cancer. Methods We searched eligible articles in MEDLINE,EMBASE （NAC） in the treatment of muscle invasive and the Cochrane database published between Jan. 1991 and Oct. 2012,and analyzed updated individual patient＇s data from all eligible randomized controlled trials （RCTs） that compared neoadjuvant chemotherapy plus local treatment with the same local treatment alone following a prespecified protocol. Results Altogether 12 RCTs of 3 296 cases entered the Meta-analysis,including 1 649 cases in the NAC plus surgery group （study group） and 1 647 in the surgery group （control group）. There was significant difference in survival between the study group and control group, odds ratio （OR） 0. 85 （95 % CI 0. 73 - 0 98, P = 0.03）. The subgroup analysis showed that the single-agent platinum chemotherapy did not lower the death risk, while the platinum-based combination chemotherapy did. Conclusion NAC especially platinum-based combination chemotherapy is beneficial to muscle-invasive bladder cancer patients.