| Objective: Evaluating and comparing efficiency and side-effects of five different bladder irrigation chemotherapy including BCG combined epirubicin, BCG combined mitomycin C, BCG vaccine, epirubicin and mitomycin C separately for superficial bladder cancer after TURBt.Methods: Pub Med(1950-2015),MEDLINE(1950-2015), EMBASE(1984-2015),the Cochrane Library,VIP(1978-2015)、CNKI(1976-2015)and CBM(1978-2015)were searched and urological magazine, degree thesis symposiums were manually searched. All available randomized controlled trials(RCTs)on the effects of postoperative bladder irrigation chemotherapy with BCG combined MMC、BCG combined EPI, BCG、EPI、MMC alone for NMIBC after TURBT were enrolled.The recurrence rate, progress rate, the rate of cystitis and hematuria were set to be the outcome indicators. Data were extracted after screening and evaluating the quality of literature according to the pre-established inclusion criteria and exclusion standard and randomized controlled trials were merged and network meta-analyzed based on the Bayesian theory with ADDIS software.Results: Seventeen randomized controlled trials including 3616 patients were enrolled in this study. It shows good convergence when potential scale cutting parameters(PSRF) are close to 1; There was no statistical significance(P>0.05) between direct and indirect evidence of inconsistence check under Node-splitting model. Compared with BCG,the recurrent rate of postoperative bladder cancer were lower in BCG+EPI and BCG+MMC bladder irrigation chemotherapy, OR recurrent rate=0.66,95%CI(0.28, 1.56);OR recurrent rate=0.84,95%CI(0.49, 1.50), but the difference among them was not statistically significant(P>0.05). Compared with BCG, the recurrence rate of postoperative bladder cancer was significantly higher in BCG+EPI and BCG+MMC bladder irrigation chemotherapy, its OR value and 95% confidence interval were 1.77(1.08, 2.81) and 1.80 (1.12, 2.86) respectively. The efficacy and side effects of five kinds of bladder perfusion treatment were ranked according to network Meta-analysis based on Bayes’ theorem, the recurrence rate: BCG+EPI<BCG+MMC<BCG<EPI<MMC; Incidence of cystitis: EPI<MMC<BCG+MMC<BCG+EPI. There was no statistically significant difference of the bladder cancer progress rate among the five kinds of bladder perfusion treatment scheme(P>0.05). The difference of incidence of hematuria was not statistically significant among five treatments(P>0.05).Conclusion: 1.Compared with BCG+MMC and BCG+EPI, there was no statistically significant difference in preventing recurrence of postoperative superficial bladder cancer in BCG bladder perfusion treatment scheme, but all of them have more advantages than MMC and EPI solution. The indirect comparison result suggest that there was no statistically significant difference with the two methods of BCG + MMC and BCG + EPI. 2. In the prevention of postoperative bladder tumor progression, there were no significant differences among the five bladder irrigation therapies: BCG+EPI, BCG+MMC, BCG, MMC and EPI. 3.Compared with the MMC and EPI treatment groups respectively, the cystitis incidence were higher in the BCG+MMC, BCG+EPI, BCG three bladder perfusion treatment group, the difference was statistically significant.4. The hematuria incidence rates were not statistically difference among five kinds of bladder perfusion treatments scheme(BCG, BCG+MMC, BCG+EPI, MMC, EPI) for superficial bladder cancer after TURBt. |
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