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You C, Li Q, Qing L, Li R, Wang Y, Cheng L, Dong Z. Device-assisted intravesical chemotherapy versus bacillus Calmette-Guerin for intermediate or high-risk non-muscle invasive bladder cancer: a systematic reviewer and meta-analysis. Int Urol Nephrol 2024; 56:103-120. [PMID: 37659995 DOI: 10.1007/s11255-023-03765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/19/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To investigate the effectiveness and safety of device-assisted intravesical chemotherapy compared to Bacillus Calmette-Guerin (BCG) in the treatment of patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). METHODS In February 2023, a systematic search was conducted on the PubMed, Cochrane, and Embase databases. Following the PRISMA guidelines, a systematic review and meta-analysis of the primary outcomes of interest were performed. The review was prospectively registered on PROSPERO under the registration number CRD42023398559. RESULTS A total of 10 studies involving 1160 patients were included. The results of the meta-analysis showed that compared to BCG, device-assisted chemotherapy had a lower recurrence rate (OR: 0.63, 95% CI: 0.48-0.84, p = 0.001), longer recurrence-free survival (OR: 0.64, 95% CI: 0.47-0.88, p = 0.006), and lower incidence of fever (OR: 0.18, 95% CI: 0.08-0.44, p = 0.0002). However, no significant differences were observed between the two groups in terms of progression, overall survival, progression-free survival, disease-free survival, overall adverse events, serious adverse events, hematuria, allergy, and general discomfort. Subgroup analysis revealed that neither chemohyperthermia (CHT) nor electromotive drug administration (EMDA) showed statistically significant differences in oncological outcomes compared to BCG. Regarding adverse events, both CHT and EMDA groups showed lower rates of fever compared to the BCG group (OR: 0.26, 95% CI: 0.10-0.67, p = 0.005, and OR: 0.14, 95% CI: 0.05-0.37, p < 0.0001, respectively). No significant differences were observed in the remaining adverse events between either the CHT or EMDA group and the BCG group. CONCLUSION Device-assisted intravesical chemotherapy appears to be a safe and viable alternative to BCG for patients with intermediate and high-risk NMIBC, showing comparable oncological outcomes and adverse events.
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Affiliation(s)
- Chengyu You
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China
| | - Qingchao Li
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China
| | - Liangliang Qing
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China
| | - Rongxin Li
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China
| | - Yanan Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China
| | - Long Cheng
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China
| | - Zhilong Dong
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China.
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China.
- Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China.
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Xu C, Jiang S, Zou L, Sheng L, Shi G, Xu B, Wang Z, Xu D, Xie X, Luo J, Guo J, Jiang H. Endoscopic balloon cryoablation plus transurethral resection for bladder cancer: A phase 2, multicenter, randomized, controlled trial. Cancer 2023; 129:415-425. [PMID: 36477612 DOI: 10.1002/cncr.34563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cryotherapy is a prevalent percutaneous ablative therapy for solid tumors. Here, we report a novel device using liquid nitrogen for endoscopic cryotherapy of bladder cancer. METHODS In this multicenter, randomized, parallel controlled, Phase 2 trial, we compared endoscopic balloon cryoablation (EBCA) with a single instillation (SI) of pirarubicin after transurethral resection (TUR). Eligible participants were randomly assigned (1:1) to the TUR-EBCA or TUR-SI group. Repeat TUR or tissue biopsies were performed to evaluate residual tumor at 4 to 6 weeks after primary treatment. The primary end point was the local control rate. The secondary end points included the tumor upgrading/upstaging, catheter indwelling duration, and adverse events. RESULTS In total, 205 patients received EBCA or SI after TUR between November 2017 and September 2020, of whom 163 completed all the required interventions. In the per-protocol set, the local control rate was 91.5% (75/82) in TUR-EBCA group compared with 76.5% (61/81) in TUR-SI group (risk difference, 15%; 95% CI, 0.03-0.27, p < .001), meeting the criteria for noninferiority. Similar results were found in the modified intention-to-treat analysis. Tumor upgrading/upstaging was found in five patients from the TUR-SI group. There was no significant difference in the catheter indwelling duration (5.1 vs. 5.2 days, p = .76) or serious adverse event rate (3.0% vs. 3.9%, p = .52). The median follow-up time of post hoc analysis was 31 (range, 15-50) months. Patients in the TUR-EBCA group had a better recurrence-free survival and progression-free survival. CONCLUSION EBCA is a safe and effective adjuvant therapy with TUR for non-muscle-invasive bladder cancer. PLAIN LANGUAGE SUMMARY This is the first randomized trial that evaluated endoscopic cryotherapy after transurethral resection (TUR) of bladder tumors. The efficacy and safety analysis shows endoscopic balloon cryoablation (EBCA) is a promising alternative. Results report that EBCA is not inferior to a single instillation of intravesical chemotherapy in eliminating residual bladder tumor. Further analysis with ∼3 years' median follow-up suggested a better prognosis in patients who received EBCA after TUR.
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Affiliation(s)
- Chenyang Xu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lujia Zou
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lu Sheng
- Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Guowei Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Xie
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Kageyama S, Maeda K, Kubota S, Yoshida T, Osafune T, Arai Y, Soga H, Nishikawa Z, Sakano Y, Takimoto K, Kim CJ, Chano T, Kawauchi A. Single Short Retention Instillation of Pirarubicin Prevents Intravesical Recurrence of Low-risk Non Muscle Invasive Bladder Cancer. In Vivo 2021; 35:1141-1145. [PMID: 33622912 PMCID: PMC8045099 DOI: 10.21873/invivo.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study evaluated the efficacy of a single instillation of pirarubicin with a short retention time for preventing intravesical recurrence of low-risk non-muscle-invasive bladder cancer. PATIENTS AND METHODS We analyzed 165 patients with low-risk non-muscle-invasive bladder cancer who underwent transurethral surgery. Single instillation of pirarubicin with 15-min retention time immediate after surgery was performed in 47 (28%) patients. The other patients (118, 72%) were treated without instillation therapy. The primary endpoint was recurrence-free survival. RESULTS Median overall follow-up was 50 (range=6-134) months. Recurrence-free survival at 1 and 5 years was 91% and 72%, and 79% and 54% in the group treated with pirarubicin, and that treated with surgery alone, respectively (p=0.031). Cox's hazard analysis revealed lack of instillation and larger tumor size (>10 mm) as significant factors for risk of recurrence. No adverse events regarding intravesical chemotherapy were observed. CONCLUSION Pirarubicin instillation with 15-min retention time can prevent intravesical recurrence of low-risk bladder tumors.
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Affiliation(s)
- Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Shiga, Japan;
| | - Koki Maeda
- Department of Urology, Shiga University of Medical Science, Shiga, Japan
- Department of Urology, Nagahama Red Cross Hospital, Shiga, Japan
| | - Shigehisa Kubota
- Department of Urology, Shiga University of Medical Science, Shiga, Japan
| | - Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Shiga, Japan
| | - Takashi Osafune
- Department of Urology, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Yutaka Arai
- Department of Urology, Kusatsu General Hospital, Shiga, Japan
| | - Hiroki Soga
- Department of Urology, Toyosato Hospital, Shiga, Japan
| | | | - Yuji Sakano
- Department of Urology, Higashi-Ohmi General Medical Center, Shiga, Japan
| | - Keita Takimoto
- Department of Urology, Saiseikai Shiga Hospital, Shiga, Japan
| | - Chul Jang Kim
- Department of Urology, Kohka Public Hospital, Shiga, Japan
| | - Tokuhiro Chano
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Shiga, Japan
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