Adjuvant chemotherapy in patients with locally advanced bladder cancer after neoadjuvant chemotherapy and radical cystectomy: a systematic review and pooled analysis

Zhiyong Cai; Hang Jin; Jinbo Chen; Jiao Hu; Huihuang Li; Zhenglin Yi; Xiongbing Zu

doi:10.21037/tau-20-571

Adjuvant chemotherapy in patients with locally advanced bladder cancer after neoadjuvant chemotherapy and radical cystectomy: a systematic review and pooled analysis

Transl Androl Urol. 2021 Jan;10(1):283-291. doi: 10.21037/tau-20-571.

Authors

Zhiyong Cai¹, Hang Jin¹, Jinbo Chen¹, Jiao Hu¹, Huihuang Li¹, Zhenglin Yi¹, Xiongbing Zu¹

Affiliation

¹ Department of Urology, Xiangya Hospital, Central South University, Changsha, China.

Abstract

Background: Neoadjuvant chemotherapy (NAC) could ameliorate the stage of locally advanced bladder cancer (LABC) which is defined in pT3/T4 and/or pN+, improve overall survival (OS) before radical cystectomy (RC). However, for LABC, the decision to use adjuvant chemotherapy (AC) after NAC and RC is still controversial.

Methods: We performed a comprehensive search of the PubMed, Embase, and Cochrane Library databases for literature that reported prognosis after using AC following NAC and RC. Cumulative analyses of hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were performed. We performed all analyses by Review Manager software, version 5.3, and Stata 15.0.

Results: Six retrospective cohort studies were included, involving 4,346 patients. Pooled analysis results showed that using AC after NAC and RC can improve OS (HR =0.83, 95% CI: 0.74-0.94, P=0.002; I² =0%) and cancer-specific survival (CSS) (HR =0.56, 95% CI: 0.32-0.99, P=0.04; I² =0%) but cannot extend recurrence-free survival (RFS) (HR =0.52, 95% CI: 0.27-1.01, P=0.05; I² =53%) for LABC patients.

Conclusions: This pooled analysis shows that AC after NAC and RC can improve the prognosis for patients with LABC.

Keywords: Urinary bladder neoplasms; adjuvant chemotherapy; meta-analysis; neoadjuvant chemotherapy (NAC).