| Background: Bladder cancer is one of the most common urinary neoplasms.In developed countries,the morbidity of bladder cancer ranks fourth in male malignant tumors,while in developing countries,it ranks seventh.Recently,the morbidity of bladder cancer in China is rising year by year.As a result,bladder cancer has become the most common male genitourinary system neoplasm in our country.The standard therapy of muscle invasive bladder cancer recommended by guideline is radical cystectomy.This surgery is at high risk with relatively high incidence of complications.Due to Pelvic lymph node dissection and urinary tract reconstruction needed in the operation,patient’s life quality will inevitably decline.Besides,many patients cannot endure radical cystectomy because of their poor physical condition.Comprehensive bladder preservation therapy is an optional therapy to such patients.Bladder preserving therapies include transurethral resection of bladder tumor(TURBT),partial cystectomy(PC),chemotherapy and radiotherapy.Recent studies showed that the combination of these therapies have the potential to achieve impressive oncologic outcomes.However,lacking of persuasive randomized controlled trials with enough cases,the efficiency of comprehensive bladder preservation therapy remains uncertain compared with radical cystectomy in term of long time survival,which limits the clinical application of this therapy.Purpose: There has been several studies reporting the effect of comprehensive bladder preservation therapy,but none of these is randomized controlled trial,resulting in the unclear of comprehensive bladder preservation therapy in term of long time survival.This study performed a comparison of 5-year survival between comprehensive bladder preservation therapy and radical cystectomy(RC)by searching and synthesizing corresponding reports to get a relatively objective and fair conclusion,which is helpful for doctors to perform optimized therapy for patients.Methods and Materials:Prospective and retrospective studies directly comparing radical cystectomy with comprehensive bladder preservation therapy from Pub Med,Chinese knowledge Network and Wanfang database were searched and collected.Considering that the cognition of bladder preservation is likely to be outdated in early studies,the author limited the publish time from January 2008 to November 2017.The keyword in Chinese is膀胱癌、保留膀胱,while English key word is Bladder preservation,muscle-invasive bladder cancer,radical cystectomy.After browsing the topic,abstract and full text sequentially,15 studies were included into the final analysis.Stata 14 software were used to conduct meta-analyses,and I2 test was conducted to assess the heterogeneity among selected studies,determining whether fixed effect model or random effect model would be applied.Then a meta-analysis evaluating5-year survival with odds ratio(HR)and 95%confidence intervals(CIs)were conducted.At last,a funnel plot was applied to describe publishing bias.Results: 1246 studies were obtained by searching databases,then 211 repeated studies were ruled out.According to the inclusion and exclusion criteria,at last 15 studies were selected.Among the 15 studies,14 studies are retrospective analysis,while 1 study is prospective analysis.10 studies are in Chinese,while 5 studies are in English.The number of patients range from 29 to 162 in these studies.In term of interventions,all of the 15 comprehensive bladder preservation therapy groups combined surgery and either chemotherapy or radiotherapy.10 studies involve radiotherapy,other 5 studies don’t apply any radiotherapy.14 studies involve chemotherapy,remaining one study doesn’t.Among 15 radical cystectomy groups,3 groups applied surgery with adjuvant radiotherapy or chemotherapy,while other 12 groups conducted surgery only.The heterogeneity of these studies is moderate,so fixed effect model was applied.Stata 14 software’s analysis showed overall OR of the 15 studies in term of 5-year overall survival is 1.06,and the 95% CI is 0.86-1.30,which indicates comprehensive bladder preservation therapy could achieve similar 5-year survival comparing with radical cystectomy.Conclusion: Comprehensive bladder preservation therapy could achieve similar long-time survival comparing with radical cystectomy in carefully chosen population.However,the bladder preserving interventions of each group are not standard,inducing heterogeneous among these bladder preservation therapies.In the future,we need more prospective randomized trials to identify the efficiency of comprehensive bladder preservation therapy and explore the optimal treatment program. |
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