Evaluating the efficacy and safety of intravesical chemotherapies for non-muscle invasive bladder cancer: a network meta-analysis
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Chuanjun Zhuo1,2,3, Xubin Li4, Hongqing Zhuang4, Shunli Tian5, Hailong Cui6, Ronghuan Jiang7, Chuanxin Liu2, Ran Tao8, Xiaodong Lin1
1Department of Psychological Medicine, Wenzhou Seventh People’s Hospital, Wenzhou, Zhejiang, 325005, China
2Department of Psychological Medicine, Jining Medical University, Jining, Shandong, 272067, China
3Department of Psychological Medicine, Tianjin Anding Hospital, Tianjin, 300222, China
4Department of Radiotherapy, Tianjin Cancer Institute and Hospital, Tianjin, 30000, China
5Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, 300075, China
6Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin, 300075, China
7Department of Psychological Medicine, Chinese PLA (People’s Liberation Army) General Hospital; Chinese PLA (People’s Liberation Army) Medical School, Beijing, 100853, China
8Beijing Shijian Integrated Medicine Science Institute, Beijing, 100700, China
Ran Tao, email: firstname.lastname@example.org
Xiaodong Lin, email: email@example.com
Keywords: non-muscle invasive bladder cancer, intravesical therapy, efficacy and safety, tumor recurrence, tumor progression
Received: July 22, 2016 Accepted: October 04, 2016 Published: October 24, 2016
Various intravesical therapies have been introduced into clinical practices for controlling non-muscle invasive bladder cancer (NMIBC). However, evidence with respect to the efficacy and safety of those intravesical therapies is very limited. Hence, we present a network meta-analysis in order to address this limitation in the current literature. The primary outcomes were the risk of tumor recurrence (TR), tumor progression (TP) and disease-specific mortality (DM). Secondary outcomes included the risk of fever, cystitis and haematuria. Conventional pair-wise and network meta-analysis were both performed for each endpoint. The surface under the cumulative ranking curve (SUCRA) was incorporated in our analysis for ranking the corresponding intravesical instillation interventions. In total, 23 randomized clinical trials (RCTs) were finally included in our study after irrelevant papers were screened out. Results of network meta-analysis suggested that Epirubicin (EPI) was less preferable than Bacille Calmette Guerin (BCG), BCG+EPI, BCG+ Isoniazid (INH), BCG+ Mytomicin C (MMC), Gemcitabine (GEM) and MMC with respect to TR. As suggested by the corresponding ranking probabilities and SUCRA, incorporating EPI or MMC into BCG may enhance the efficacy of BCG monotherapy.
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