| Objective:Neoadjuvant chemotherapy(NAC)was supported by levelⅠevidence and has been recommended for patients with muscle invasive bladder cancer(MIBC),but the utilization status of it remains unknown.This meta-analysis aimed to give a comprehensive depict of NAC modality in MIBC populations.Methods:Electronic databases including CNKI,WanFang Data,SinoMed,Pubmed,EMbase,Web of Science,and The Cochrane Library were searched.Cross-sectional or observational studies investigated or referred to the utilization status of NAC in MIBC populations,and providing data of baseline information,utilization rate of NAC and other variables of interest were included.The primary outcomes for meta-analysis were utilization rate of NAC,its utility distribution in different genders,races,ages,countries and temporal trends,NAC regimens,response outcomes after the use of NAC and the potential factors affected the utility of NAC.The utilization rates of NAC were calculated as‘Proportion(s)’(the number of patients administrated with NAC divided by the total number of participants who were diagnosed with MIBC)with 95%confidence intervals(CIs)and pooled estimates were calculated using a random effects model.All data analyses were performed using Stata version 12.0.Results:A total of nineteen studies and 57,897 patients were included.The total proportion of NAC applied in MIBC populations prior to radical cystectomy(RC)was 18.1%(95%CI:14.2%-22.1%,I~2=99.7%).The comparative analyses showed no significant differences of NAC utilization rates between males and females and between the white and black populations,respectively.With regard to age distribution of NAC,<60 age group conferred higher utilization rate of NAC than the older(OR=1.919,95%CI:1.671-2.202,P=0.0001).As for regional distribution,our meta-analysis showed that Japan(Proportion:44.0%,95%CI:6.5%-81.5%,I~2=99.6%),Sweden(Proportion:37.9%,95%CI:34.9%-40.8%)and the United States(Proportion:16.6%,95%CI:9.9%-23.3%,I~2=99.8%)were the three leading countries,of included studies,contributing to the most frequent application of NAC.With regard to neoadjuvant modalities,the cisplatin-and carboplatin-based regimens were applied in 61%(95%CI:28.8%-93.2%,I~2=99.2%)and 50%(95%CI:0.1%-99.9%,I~2=99.0%)populations,respectively.As for the pathologic responses after NAC,complete,partial and down-staged pathologic responses were achieved in 16.4%(Proportion:16.4%,95%CI:9.8%-22.9%,I~2=82.4%),15.9%(95%CI:5.1%-26.7%,I~2=85.2%)and 35.4%(95%CI:19.7%-51.2%,I~2=95.7%)patients,respectively.Conclusions:The present study shows the low utilization rate of NAC in MIBC patients.For the treatment patterns,cisplatin-based chemotherapy confers the most frequent used regimen and carboplatin-based regimens contribute to the usual substitutions.Down-staged,complete or partial pathologic responses can be achieved in MIBC populations with the use of NAC.In the future,standardization of the treatment modality of MIBC and promotion of guidelines may expedite the adoption of NAC. |
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