Adjuvant chemotherapy for invasive bladder cancer: A 2013 updated systematic review and meta-analysis of randomized trials

Jeffrey J. Leow, William Martin-Doyle, Padma S. Rajagopal, Chirayu G. Patel, Erin M. Anderson, Andrew T. Rothman, Richard J Cote, Yuksel Urun, Steven L. Chang, Toni K. Choueiri, Joaquim Bellmunt

Research output: Contribution to journalArticle

215 Citations (Scopus)

Abstract

Context The role of adjuvant chemotherapy remains poorly defined for the management of muscle-invasive bladder cancer (MIBC). The last meta-analysis evaluating adjuvant chemotherapy, conducted in 2005, had limited power to fully support its use. Objective To update the current evidence of the benefit of postoperative adjuvant cisplatin-based chemotherapy compared with control (ie, surgery alone) in patients with MIBC. Evidence acquisition A comprehensive literature review was performed to identify all randomized controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy with control for patients with MIBC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to May 2013. An updated systematic review and meta-analysis was performed. Evidence synthesis A total of 945 patients included in nine RCTs (five previously analyzed, one updated, and three new) were examined. For overall survival, the pooled hazard ratio (HR) across all nine trials was 0.77 (95% confidence interval [CI], 0.59-0.99; p = 0.049). For disease-free survival, the pooled HR across seven trials reporting this outcome was 0.66 (95% CI, 0.45-0.91; p = 0.014). This disease-free survival benefit was more apparent among those with positive nodal involvement (p = 0.010). Conclusions This updated and improved meta-analysis of randomized trials provides further evidence of an overall survival and disease-free survival benefit in patients with MIBC receiving adjuvant cisplatin-based chemotherapy after radical cystectomy.

Original languageEnglish
Pages (from-to)42-54
Number of pages13
JournalEuropean Urology
Volume66
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Meta-Analysis
Cisplatin
Disease-Free Survival
Muscles
Drug Therapy
Randomized Controlled Trials
Confidence Intervals
Survival
Cystectomy
Databases

Keywords

  • Adjuvant chemotherapy
  • Meta-analysis
  • Muscle-invasive bladder cancer
  • Perioperative chemotherapy

ASJC Scopus subject areas

  • Urology

Cite this

Leow, J. J., Martin-Doyle, W., Rajagopal, P. S., Patel, C. G., Anderson, E. M., Rothman, A. T., ... Bellmunt, J. (2014). Adjuvant chemotherapy for invasive bladder cancer: A 2013 updated systematic review and meta-analysis of randomized trials. European Urology, 66(1), 42-54. https://doi.org/10.1016/j.eururo.2013.08.033

Adjuvant chemotherapy for invasive bladder cancer : A 2013 updated systematic review and meta-analysis of randomized trials. / Leow, Jeffrey J.; Martin-Doyle, William; Rajagopal, Padma S.; Patel, Chirayu G.; Anderson, Erin M.; Rothman, Andrew T.; Cote, Richard J; Urun, Yuksel; Chang, Steven L.; Choueiri, Toni K.; Bellmunt, Joaquim.

In: European Urology, Vol. 66, No. 1, 01.01.2014, p. 42-54.

Research output: Contribution to journalArticle

Leow, JJ, Martin-Doyle, W, Rajagopal, PS, Patel, CG, Anderson, EM, Rothman, AT, Cote, RJ, Urun, Y, Chang, SL, Choueiri, TK & Bellmunt, J 2014, 'Adjuvant chemotherapy for invasive bladder cancer: A 2013 updated systematic review and meta-analysis of randomized trials', European Urology, vol. 66, no. 1, pp. 42-54. https://doi.org/10.1016/j.eururo.2013.08.033
Leow, Jeffrey J. ; Martin-Doyle, William ; Rajagopal, Padma S. ; Patel, Chirayu G. ; Anderson, Erin M. ; Rothman, Andrew T. ; Cote, Richard J ; Urun, Yuksel ; Chang, Steven L. ; Choueiri, Toni K. ; Bellmunt, Joaquim. / Adjuvant chemotherapy for invasive bladder cancer : A 2013 updated systematic review and meta-analysis of randomized trials. In: European Urology. 2014 ; Vol. 66, No. 1. pp. 42-54.
@article{20bc042ee1f74c1aa152a8c3edb21496,
title = "Adjuvant chemotherapy for invasive bladder cancer: A 2013 updated systematic review and meta-analysis of randomized trials",
abstract = "Context The role of adjuvant chemotherapy remains poorly defined for the management of muscle-invasive bladder cancer (MIBC). The last meta-analysis evaluating adjuvant chemotherapy, conducted in 2005, had limited power to fully support its use. Objective To update the current evidence of the benefit of postoperative adjuvant cisplatin-based chemotherapy compared with control (ie, surgery alone) in patients with MIBC. Evidence acquisition A comprehensive literature review was performed to identify all randomized controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy with control for patients with MIBC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to May 2013. An updated systematic review and meta-analysis was performed. Evidence synthesis A total of 945 patients included in nine RCTs (five previously analyzed, one updated, and three new) were examined. For overall survival, the pooled hazard ratio (HR) across all nine trials was 0.77 (95{\%} confidence interval [CI], 0.59-0.99; p = 0.049). For disease-free survival, the pooled HR across seven trials reporting this outcome was 0.66 (95{\%} CI, 0.45-0.91; p = 0.014). This disease-free survival benefit was more apparent among those with positive nodal involvement (p = 0.010). Conclusions This updated and improved meta-analysis of randomized trials provides further evidence of an overall survival and disease-free survival benefit in patients with MIBC receiving adjuvant cisplatin-based chemotherapy after radical cystectomy.",
keywords = "Adjuvant chemotherapy, Meta-analysis, Muscle-invasive bladder cancer, Perioperative chemotherapy",
author = "Leow, {Jeffrey J.} and William Martin-Doyle and Rajagopal, {Padma S.} and Patel, {Chirayu G.} and Anderson, {Erin M.} and Rothman, {Andrew T.} and Cote, {Richard J} and Yuksel Urun and Chang, {Steven L.} and Choueiri, {Toni K.} and Joaquim Bellmunt",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.eururo.2013.08.033",
language = "English",
volume = "66",
pages = "42--54",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Adjuvant chemotherapy for invasive bladder cancer

T2 - A 2013 updated systematic review and meta-analysis of randomized trials

AU - Leow, Jeffrey J.

AU - Martin-Doyle, William

AU - Rajagopal, Padma S.

AU - Patel, Chirayu G.

AU - Anderson, Erin M.

AU - Rothman, Andrew T.

AU - Cote, Richard J

AU - Urun, Yuksel

AU - Chang, Steven L.

AU - Choueiri, Toni K.

AU - Bellmunt, Joaquim

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Context The role of adjuvant chemotherapy remains poorly defined for the management of muscle-invasive bladder cancer (MIBC). The last meta-analysis evaluating adjuvant chemotherapy, conducted in 2005, had limited power to fully support its use. Objective To update the current evidence of the benefit of postoperative adjuvant cisplatin-based chemotherapy compared with control (ie, surgery alone) in patients with MIBC. Evidence acquisition A comprehensive literature review was performed to identify all randomized controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy with control for patients with MIBC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to May 2013. An updated systematic review and meta-analysis was performed. Evidence synthesis A total of 945 patients included in nine RCTs (five previously analyzed, one updated, and three new) were examined. For overall survival, the pooled hazard ratio (HR) across all nine trials was 0.77 (95% confidence interval [CI], 0.59-0.99; p = 0.049). For disease-free survival, the pooled HR across seven trials reporting this outcome was 0.66 (95% CI, 0.45-0.91; p = 0.014). This disease-free survival benefit was more apparent among those with positive nodal involvement (p = 0.010). Conclusions This updated and improved meta-analysis of randomized trials provides further evidence of an overall survival and disease-free survival benefit in patients with MIBC receiving adjuvant cisplatin-based chemotherapy after radical cystectomy.

AB - Context The role of adjuvant chemotherapy remains poorly defined for the management of muscle-invasive bladder cancer (MIBC). The last meta-analysis evaluating adjuvant chemotherapy, conducted in 2005, had limited power to fully support its use. Objective To update the current evidence of the benefit of postoperative adjuvant cisplatin-based chemotherapy compared with control (ie, surgery alone) in patients with MIBC. Evidence acquisition A comprehensive literature review was performed to identify all randomized controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy with control for patients with MIBC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to May 2013. An updated systematic review and meta-analysis was performed. Evidence synthesis A total of 945 patients included in nine RCTs (five previously analyzed, one updated, and three new) were examined. For overall survival, the pooled hazard ratio (HR) across all nine trials was 0.77 (95% confidence interval [CI], 0.59-0.99; p = 0.049). For disease-free survival, the pooled HR across seven trials reporting this outcome was 0.66 (95% CI, 0.45-0.91; p = 0.014). This disease-free survival benefit was more apparent among those with positive nodal involvement (p = 0.010). Conclusions This updated and improved meta-analysis of randomized trials provides further evidence of an overall survival and disease-free survival benefit in patients with MIBC receiving adjuvant cisplatin-based chemotherapy after radical cystectomy.

KW - Adjuvant chemotherapy

KW - Meta-analysis

KW - Muscle-invasive bladder cancer

KW - Perioperative chemotherapy

UR - http://www.scopus.com/inward/record.url?scp=84902117954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902117954&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2013.08.033

DO - 10.1016/j.eururo.2013.08.033

M3 - Article

C2 - 24018020

AN - SCOPUS:84902117954

VL - 66

SP - 42

EP - 54

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 1

ER -