Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with non-muscle invasive bladder cancer? An update and cumulative meta-analysis

doi:10.1007/s11684-014-0328-0

Front. Med.

2014, Vol. 8

Issue (2) : 241-249 https://doi.org/10.1007/s11684-014-0328-0

RESEARCH ARTICLE

Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with non-muscle invasive bladder cancer? An update and cumulative meta-analysis

Jiangang Pan^1,^*(

),Mo Liu²,Xing Zhou¹

1. The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
2. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China

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Abstract

Approximately 70% of newly diagnosed bladder tumors are non-muscle invasive bladder cancer (NMIBC). NMIBC accounts for approximately 80% of total bladder cancer cases. Bacillus Calmette-Guérin (BCG) instillation and maintenance is considered as the standard adjuvant treatment for superficial bladder cancer. A number of randomized studies have focused on the benefit of maintenance therapy following initial BCG induction. To provide further insights into the effect of intravesical instillation on recurrence in patients with NMIBC, we analyzed this relationship by conducting an updated detailed meta-analysis. Evidence suggested that adjuvant intravesical BCG with maintenance treatment is significantly effective for the prophylaxis of tumor recurrence in patients with NMIBC.

Keywords non-muscle invasive bladder cancer bacillus Calmette-Guérin (BCG) meta-analysis

Corresponding Author(s): Jiangang Pan

Issue Date: 21 May 2014

Cite this article:

Jiangang Pan,Mo Liu,Xing Zhou. Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with non-muscle invasive bladder cancer? An update and cumulative meta-analysis[J]. Front. Med., 2014, 8(2): 241-249.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-014-0328-0
https://academic.hep.com.cn/fmd/EN/Y2014/V8/I2/241

Tab.1 Table 1 Trial characteristics (n = 48)

Fig.1 PRISMA flow diagram for the trial. Randomized clinical trial.

Tab.2 Table 2 Trial characteristics (n = 48)

Study, year of publication	Location and year(s) of study	BCGn/N	No BCGn/N	Instillation schedules	Disease type	BCG strain
Yoo KH et al., 2012	Korea, 2000–2009	33/92	21/34	BCG maintenance/BCG initiation therapy	Ta, T1, CIS	Tice
Gülpinar Ö et al., 2012	Turkey, 2004–2006	9/25	5/26	BCG initiation therapy/BCG initiation therapy and perioperative MMC	Ta, T1, CIS	Not mentioned
Matsumoto K et al., 2012	Japan, 1985–2008	48/11948/119	19/2423/40	BCG initiation therapy/ChemotherapyBCG initiation therapy/TUR alone	Ta, T1, CIS	Connaught
Cho IC et al., 2012	Korea	16/53	15/54	BCG maintenance/MMC	T1G3	RIVM
Okamura T et al., 2012	Japan, 1989–2006	8/48	13/27	BCG maintenance/BCG initiation therapy	Ta, T1, CIS	Tokyo
Chen CH et al. , 2012	Taiwan,1996–2004	22/6222/62	36/6566/114	BCG maintenance/doxorubicinBCG maintenance/MMC, doxorubicin, and cisplatin	Ta, T1	Pasteur
Hinotsu S et al., 2011	Japan	6/416/4117/42	17/4223/3223/32	BCG maintenance/BCG initiation therapyBCG maintenance/EpirubicinBCG initiation therapy/Epirubicin	Ta, T1, CIS	Connaught
Oosterlinck W et al., 2011	Turkey, Italy, etc., 2001–2005	26/48	23/48	BCG maintenance/BCG maintenance and MMC	CIS	Tice
Koga H et al., 2010	Japan, 2002–2005	12/24	15/27	BCG maintenance/BCG initiation therapy	Ta, T1, CIS	Tokyo
Porena M et al., 2010	Italy, 2004–2006	9/32	17/32	BCG maintenance/Gemcitabine	Ta, T1, CIS	Tice
Di Lorenzo G et al., 2010	Italy, 2006–2008	21/40	35/40	BCG maintenance/Gemcitabine	Ta, T1	Connaught
Cho DY et al., 2009	Korea, 2005–2006	17/51	14/36	BCG initiation therapy/BCG & Gemcitabine	Ta, T1, CIS	Tice
Sylvester RJ et al., 2010	Europe, 1992–1997	103/281103/281	147/279110/277	BCG maintenance/EpirubicinBCG maintenance/BCG & Isoniazid	Ta, T1	Tice
Duchek M et al., 2010	Europe, 1999–2006	34/126	47/124	BCG maintenance/Epirubicin & INF	T1	Tice
Riikka Ja¨rvinen et al., 2009	Finland, 1984–1987	26/44	36/45	BCG maintenance/MMC	Ta, T1, CIS	Pasteur
Yi SH et al., 2008	China, 2004–2007	3/21	0/24	BCG maintenance/BCG & Hydroxycamptothecin	Ta, T1, CIS	Not mentioned
Cai T et al., 2008	Italy, 2005–2007	40/81	34/80	BCG initiation therapy/BCG & Epirubicin	Ta, T1, CIS	Not mentioned
Ojea A et al., 2007	CUETO, 1995–1998	38/14250/139	58/14958/149	BCG maintenance (27 mg)/MMCBCG maintenance (13.5 mg)/MMC	Ta, T1	Connaught
Friedrich MG et al., 2007	Germany, 1995–2002	41/16341/163	46/17916/153	BCG initial therapy/MMC 6 weeksBCG initial therapy/MMC 3 years	Ta	RIVM
Hinotsu S et al., 2006	Japan, 1998–2002	21/40	13/40	BCG initial therapy/doxorubicin	Ta, T1	Tokyo
Di Stasi SM et al., 2006	Italy, 1994–2002	26/105	38/107	BCG initial therapy/BCG & MMC	Ta, T1, CIS	Connaught
Startsev V et al., 2005	Russia, 2002–2003	11/60	21/82	BCG initial therapy/chemotherapy	Ta, T1, CIS	Not mentioned
Cheng CW et al., 2005	China, 1991–1999	30/102	59/107	BCG maintenance/Epirubicin	Ta, T1, CIS	Connaught
de Reijke TM et al., 2005	Netherlands, 1993–1999	53/81	45/80	BCG maintenance/Epirubicin	Ta, T1, CIS	Connaught
Yumura Y et al., 2004	Japan	4/19	8/15	BCG initial therapy/TUR alone	T1G3	Tokyo
Peyromaure M et al., 2004	France, 1991–2001	24/5724/57	8/102/7	BCG maintenance/MMCBCG maintenance/TUR alone	T1G3	Pasteur
Kaasinen E et al., 2003	Nordic, 1992–1997	65/145	87/159	BCG maintenance/BCG & MMC	CIS	Connaught
Librenjak D et al., 2003	Croatia, 1989–1994	36/80	68/90	BCG maintenance/TUR alone	Ta, T1	Pasteur
Hara I et al., 2003	Japan, 1995–1997	22/34	55/63	BCG initial therapy/chemotherapy	T1	Not mentioned
Shahin O et al., 2003	Switzerland	64/92	46/61	BCG initial therapy/TUR alone	T1G3	Pasteur
Kaasinen E et al., 2002	Finland, 1992–1996	48/102	64/103	BCG maintenance/BCG & IFN	Ta, T1	Tice
Patard JJ et al., 2002	France,1979–1996	25/50	27/30	BCG maintenance/TUR alone	T1G3	Pasteur
Kolodziej A et al., 2002	Poland,1996–2002	19/102	29/53	BCG maintenance/TUR alone	Ta, T1, CIS	Tice
Chepurov AK et al., 2002	Russia	25/51	7/11	BCG maintenance/BCG initiation therapy	Ta, T1, CIS	Not mentioned
Kulkarni JN et al., 2002	India, 1991–1999	32/69	8/22	BCG initiation therapy/TUR alone	T1G3	Danish
Sekine H et al., 2001	Japan, 1998–1999	2/21	11/21	BCG initial therapy/chemotherapy	CIS	Not mentioned
van der Meijden AP et al., 2001	Netherlands	91/281	131/279	BCG maintenance/chemotherapy	Ta, T1	Not mentioned
Tozawa K et al., 2001	Japan, 1996–1999	16/50	6/23	BCG maintenance/BCG & Epirubicin	Ta, T1	Tokyo
Palou J et al., 2001	Spain, 1989–1995	56/66	45/61	BCG maintenance/BCG initiation therapy	CIS	Connaught
Lamm DL et al., 2000	USA	108/192	142/192	BCG maintenance/BCG initiation therapy	Ta, T1, CIS	Connaught
Altay B et al., 2000	Turkey	16/6116/61	10/4010/40	BCG initiation therapy/TUR aloneBCG initiation therapy/chemotherapy	Ta, T1	Not mentioned
Bilen CY et al., 2000	Turkey, 1994–1995	4/21	3/20	BCG initiation therapy/BCG & Epirubicin	Ta, T1, CIS	Connaught
Moyano Calvo JL et al., 1999	Spain	43/111	89/124	BCG initiation therapy/TUR alone	Ta, T1	Not mentioned
Malmstrom PU et al., 1999	Sweden	59/125	49/125	BCG maintenance/MMC	Ta, T1, CIS	Pasteur
Witjes JA et al., 1998	Netherlands	35/90	42/92	BCG initiation therapy/MMC	Ta, T1, CIS	Not mentioned
Witjes JA et al., 1998	EORTC, 1985–1986	76/159	72/168	BCG initiation therapy/MMC	Ta, T1, CIS	RIVM
Ayed M et al.,1998	French	25/66	84/123	BCG maintenance/MMC	Ta,T1	Pasteur
Jimenez-Cruz JF et al.,1997	Spain	24/61	34/49	BCG maintenance/INF	T1	Pasteur

Tab.3 Table 3 Descriptive characteristics of studies used in the meta-analysis

Fig.2 Funnel plot of log OR of recurrent NMIBC according to the SEs of all studies in analysis. Begg’s test (P = 0.21) and Egger test for publication bias (P = 0.30).

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