| Objective:The clinical efficacy and safety of neoadjuvant chemotherapy in the treatment of muscle-invasive bladder cancer were systematically evaluated in order to provide a theoretical basis for clinical treatment,provide an effective treatment method for patients with bladder cancer,prolong the survival period of patients and improve the prognosis of patients.Methods:Meta analysis was used to search the literature with computers.The Chinese database includes CNKI,Wanfang,and Weipu Medicine,and the English database includes Pubmed,Database,and Cochrane Library.The literature on neoadjuvant chemotherapy for bladder cancer since 2000 was retrieved.Two researchers screened the literature strictly in accordance with the inclusion and exclusion criteria,extracted basic information such as the name of the first author of the literature,year of publication,country or region,sample size,gender of the study object,age of the study object,disease type,treatment plan,and related outcome indicators,and used the RCT risk assessment tool to evaluate the quality of the included literature,At the same time,use the Review Manager 5.3 software provided by the Cochrane collaboration network for statistical analysis.Results:1.Characteristics of the included literature: A total of 16 literature materials were included,with a total sample size of 1850 cases,including 883 cases in the study group and967 cases in the control group.The study group received neoadjuvant chemotherapy regimens,including vinblastine+methotrexate+doxorubicin+cisplatin(MVAC),gemcitabine+cisplatin(GC),and the control group received non neoadjuvant chemotherapy,including surgery,radiotherapy,or symptomatic treatment,The overall quality score of the literature is relatively good;2.Efficacy related indicators: The median survival time in the study group was significantly higher than that in the control group [MD=5.54,95% CI: 4.63-6.46,Z=11.86,P<0.001];The tumor diameter in the study group was significantly lower than that in the control group [MD=-0.64,95% CI:-0.91 to-0.38,Z=4.69,P<0.001];The objective response rate in the study group was significantly higher than that in the control group(OR=1.77,95% CI: 1.09-2.87,Z=2.30,P=0.02);The disease control rate in the study group was significantly higher than that in the control group [OR=4.13,95% CI: 2.41-7.07,Z=5.17,P<0.001];3.Recurrence,death,and survival rate: The recurrence rate in the study group was significantly lower than that in the control group [OR=0.44,95% CI: 0.33-0.58,Z=5.62,P<0.001];There was no significant difference in mortality between the study group and the control group [OR=0.60,95% CI: 0.36-1.00,Z=1.95,P=0.05];The survival rate in the study group was significantly higher than that in the control group [OR=2.03,95% CI:1.58-2.60,Z=5.59,P<0.001];4.Safety: There was no significant difference in the incidence of adverse reactions in the blood system between the study group and the control group [OR=0.64,95% CI:0.38-1.10,Z=1.60,P=0.11];The incidence of digestive adverse reactions in the study group was significantly lower than that in the control group [OR=0.59,95% CI: 0.40 to0.88,Z=2.60,P=0.009];The incidence of renal function damage in the study group was significantly lower than that in the control group [OR=0.32,95% CI: 0.14-0.74,Z=2.67,P=0.008].Conclusion:The neoadjuvant chemotherapy scheme is effective in preoperative adjuvant treatment of myometrial invasive bladder cancer patients.It can effectively prolong the survival time of patients,reduce the tumor diameter of patients,improve the objective remission rate and disease control rate of patients,reduce the recurrence rate and mortality of patients after surgery,and will not increase the risk of adverse reactions such as blood system,digestive system,liver and kidney function damage of patients.It has good treatment safety. |
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