Efficacy Of Mitomycin Combined With BCG And BCG Alone: A Systematic Review And Meta Analysis

Background:At present,it is not clear whether the effect of BCG combined with mitomycin maintenance therapy(MMC)on bladder perfusion after transurethral resection of bladder tumor(TURBT)is better than the effect of BCG on a single drug.This systematic review and meta-analysis aims to clarify the therapeutic effect of BCG combined with mitomycin bladder perfusion for middle and high risk bladder cancer patients.Methods: We conducted a comprehensive literature search on Pub Med,EMBASE,The Cochrane Library,other databases,and randomized controlled trials(RCTS)on more related topics.These trials have compared the therapeutic effects of combination therapy and BCG monotherapy.The experimental group received intravesical instillation of BCG at first,followed by alternate instillation of mitomycin and BCG for at least one year,while the control group only received intravesical instillation of BCG for the same duration as the combined group.This systematic review and meta-analysis were performed according to the PRISMA checklist.Results:A total of 7 randomized controlled trials(RCTS)were retrieved and included in this systematic review and meta-analysis.According to the meta-analysis results of this study,patients with intermediate and high-risk non-muscular invasive bladder malignancies(NMIBC)have been combined with mitomycin replacement(MMC)for more than one year after transurethral resection of bladder tumor(TURBT)and alone Compared with BCG treatment,regular bladder infusion therapy greatly reduces the recurrence rate of bladder cancer after treatment(TURBT)(RR = 0.53;95%CI = 0.05)At the same time,the progression rate(RR = 0.52;95% CI 0.25-1.06;P =0.07)and mortality rate(RR = 0.62;95% CI 0.35-1.08;P = 0.09)of bladder cancer also showed a decreasing trend,But it did not show obvious statistical significance.However,the incidence of adverse reactions may increase slightly after combination therapy,but reducing the dose of avulsomycin(MMC)can reduce the risk of adverse reactions.However,there are few prospective randomized controlled studies related to this conclusion,and most of the data are not detailed,so we did not conduct a metaanalysis related to this conclusion.At the same time,these conclusions should be considered more carefully,because the quality of evidence of these conclusions is relatively low.Subgroup analysis showed that higher dose of MMC combined with perfusion therapy showed better therapeutic effect,but it also means that the difference of mitomycin perfusion measurement in the included literature may be one of the sources of potential clinical heterogeneity.Conclusion: For non-muscular invasive bladder malignant tumors(NMIBC),in intermediate and high-risk patients,transurethral resection of bladder tumors(TURBT),followed by alternating avulsomycin(MMC)and BCG vaccine(BCG)and chemotherapy Used together for bladder infusion,it can greatly reduce the overall recurrence rate and 5-year recurrence rate of bladder cancer patients after surgery,and has a trend of alleviating tumor progression and reducing mortality.progression compared with intravesical instillation of BCG alone after TURBT The trend of However,the incidence of adverse reactions after combined infusion therapy may increase,and the increase in the incidence half a year before the infusion is particularly obvious,and according to the current relevant studies,there is no clear statistical significance.However,these conclusions should be handled with caution because of the low quality of the evidence..At the same time,the optimal maintenance strategy,perfusion time and perfusion method to further reduce the adverse reactions after combined perfusion are still unclear.It is still necessary to conduct large-scale,multi institution bladder perfusion study for patients with medium and high-risk bladder cancer after TURBT to determine the optimal maintenance strategy,perfusion time and the way to reduce the adverse reactions after perfusion.