The aim of the study was to systematically review the relevant studies to evaluate the prognosis of primary and progressive muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC) and provide a clue for the timing of RC in patients with progressive MIBC early at the time of high-risk non-muscle-invasive bladder cancer (NMIBC).
PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for eligible studies. We extracted hazard ratios (HRs) of overall survival (OS) and cancer-specific survival (CSS) and deaths at 5 and 10 years for each study and performed the meta-analysis using Review Manager 5.3.
A total of 11 retrospective studies with 4102 patients were included in the meta-analysis. The pooled analysis suggested a similar CSS (HR: 1.18; 95% CI, 0.74, 1.87; p = 0.50) and OS (HR: 1.15; 95% CI, 0.82, 1.61; p = 0.43) between primary and progressive MIBC patients treated with RC. The results further indicated no significant differences between the two populations in terms of 5-year CSS rate (OR: 1.32; 95% CI, 0.90, 1.95; p = 0.16), 10-year CSS rate (OR: 0.83; 95% CI, 0.37, 1.83; p = 0.64) as well as 5-year OS rate (OR: 1.02; 95% CI, 0.66, 1.56; p = 0.94). Subgroup analysis according to the starting point of follow-up showed similar outcomes.
The meta-analysis demonstrates comparable CSS and OS in patients with the primary and progressive MIBC following RC. Novel risk stratifications and prospective trials are urgent needed to investigate the prognosis after RC of these two groups of patients, which could finally aid clinician decision making and select patients who would actually benefit from early RC.
International journal of surgery (London, England). 2018 Feb 26 [Epub ahead of print]
Junru Chen, Haoran Zhang, Guangxi Sun, Xingming Zhang, Jinge Zhao, Jiandong Liu, Pengfei Shen, Ming Shi, Hao Zeng
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China. Electronic address: ., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China. Electronic address: .