Background:Non-muscle-invasive bladder cancer (NMIBC) comprises about 75% of all bladder cancers. Although NMIBC is treatable, it poses significant costs and burdens to patients due to high recurrence rates. We conducted an updated meta-analysis of studies that evaluated the efficacy of and outcomes after treatment with mitomycin C (MMC), gemcitabine (GEM), and docetaxel (DOCE) for NMIBC recurrence and progression.Methods:We searched the PubMed and Cochrane databases for observational cohort studies and randomized clinical trials (RCT) conducted between 2009 and 2022 that assessed the efficacy of GEM, DOCE, or MMC, alone or in combination, regarding NMIBC outcomes. A total of 49 studies that met the inclusion criteria were reviewed for their quality, sample size, outcomes, and potential for bias, and relevant data were extracted for the meta-analysis. Separate meta-analyses were performed to assess the risks of recurrence or progression when comparing GEM/DOCE or MMC vs. other treatments. Study heterogeneity was assessed by I2statistics.Results:Among 31 studies comparing GEM or MMC to other treatments for NMIBC recurrence, there were statistically significant risk reductions of 24% for GEM (pooled relative risk (RR) of 0.76; 95% confidence interval (CI) 0.64–0.87) and 37% for MMC (pooled RR = 0.63; 95% CI 0.58–0.68). Recurrence-free survival (RFS) for GEM or MMC alone was 69.5% (95% CI 66.6–72.3%) and 67.2% (95% CI 66.2–68.2%), respectively. Studies assessing the combination of treatments had a pooled RFS of 44.6% (95% CI 40.4–48.7%). Fewer studies examined the risk of NMIBC progression, with large variability and inconclusive results across them.Conclusions:Our findings corroborate recent guidelines indicating that both GEM and MMC are effective treatments that reduce tumor recurrence and improve survival of NMIBC, although with large variability across the studies. Fewer studies evaluated DOCE treatment, with inconclusive results. Women and minorities were generally underrepresented, raising concerns about the generalizability of the findings and highlighting the importance of including a broader patient population in future RCTs.
背景：非肌层浸润性膀胱癌约占所有膀胱癌的75%。尽管非肌层浸润性膀胱癌可治疗，但由于高复发率，给患者带来了显著的经济负担和健康压力。本研究对评估丝裂霉素C、吉西他滨和多西他赛治疗非肌层浸润性膀胱癌复发和进展的疗效及预后的研究进行了更新的荟萃分析。 方法：我们检索了PubMed和Cochrane数据库中2009年至2022年间发表的观察性队列研究和随机临床试验，这些研究评估了吉西他滨、多西他赛或丝裂霉素C（单独或联合使用）对非肌层浸润性膀胱癌预后的疗效。共纳入49项符合标准的研究，对其质量、样本量、结果和潜在偏倚进行了评估，并提取相关数据进行荟萃分析。分别进行荟萃分析以评估吉西他滨/多西他赛或丝裂霉素C与其他治疗相比的复发或进展风险。研究异质性通过I²统计量进行评估。 结果：在31项比较吉西他滨或丝裂霉素C与其他治疗非肌层浸润性膀胱癌复发的研究中，吉西他滨的复发风险显著降低24%（合并相对风险为0.76；95%置信区间0.64–0.87），丝裂霉素C降低37%（合并相对风险为0.63；95%置信区间0.58–0.68）。单独使用吉西他滨或丝裂霉素C的无复发生存率分别为69.5%（95%置信区间66.6–72.3%）和67.2%（95%置信区间66.2–68.2%）。评估联合治疗的研究合并无复发生存率为44.6%（95%置信区间40.4–48.7%）。评估非肌层浸润性膀胱癌进展风险的研究较少，结果存在较大差异且结论不明确。 结论：我们的研究结果证实了近期指南的结论，即吉西他滨和丝裂霉素C均是降低非肌层浸润性膀胱癌肿瘤复发并提高生存率的有效治疗方法，尽管各研究间存在较大差异。评估多西他赛治疗的研究较少，结果尚不明确。女性和少数族裔在研究中代表性普遍不足，这引发了对研究结果普适性的担忧，并突显了在未来随机临床试验中纳入更广泛患者群体的重要性。
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