Meta-Analysis Of The Efficacy And Safety Of Neoadjuvant Chemotherapy For Myometrial Invasive Bladder Cancer

Objective: To systematically evaluate the efficacy and safety of neoadjuvant chemotherapy for myometrial invasive bladder cancer,in order to provide evidence for clinical medication in a certain extent.Methods: A computer search was conducted on CNKI database,Wan fang database,VIP medical database,Pub Med,Cochrane Library,EMBASE,web of science,and the time and type of retrieval were set up for all randomized controlled trials(RCTs)since the establishment of the database to new adjuvant chemotherapy for myometrial invasive bladder cancer in January 1,2022.Two researchers strictly followed the inclusion and exclusion criteria set out in this study,and retrieved,screened and checked the literature using Endnote 11 software.If there is any objection,the third researcher shall be added to make a decision after consultation;For the finally included literature,the Cochrane manual bias risk assessment tool is used for quality evaluation.The evaluation contents include: whether the randomization allocation sequence is correct,whether the randomization sequence is hidden,whether the blind method is adopted,whether the blind method is perfect,whether the data is complete,whether the selective report exists,whether the baseline of the study group and the control group is balanced,and whether other types of bias exist,Each item shall be evaluated with "low risk of bias","unclear risk of bias" and "high risk of bias",and he results were cross checked and evaluated by two researchers.In case of dispute,the third highly qualified researcher shall intervene and decide after consultation;Revman 5.4 software provided by Cochrane Collaboration Network was used for meta-analysis of the included literature data.Result:A total of 20 RCTs were included in this meta-analysis,including 4459 patients,1935 cases of neoadjuvant chemotherapy and 2524 cases of non-neoadjuvant chemotherapy.The results showed that after neoadjuvant chemotherapy,MIBC had bladder retention(OR=2.70,95%CI:1.09～6.65,P<0.05),decreased to p T0(OR=3.44,95%CI: 13～8.28,P<0.01),decreased to p T1(OR=0.63,95%CI:0.43～0.93,P<0.05),complete remission rate(OR=2.18,95%CI:1.28～3.71,P<0.01),3-year survival rate(OR=1.28,95%CI:1.02～1.60,P<0.05).The 5-year survival rate(OR=1.46,95%CI:1.11～1.92,P<0.01)and recurrence rate(OR=0.79,95%CI:0.64～0.97,P<0.05)were significantly better than those in the non-neoadjuvant chemotherapy group;The adverse reactions in renal dysfunction(OR=2.95,95%CI:1.30～6.66,P<0.01),anemia(OR=4.70,95%CI:1.71～12.91,P<0.01),neutropenia(OR=20.53,95%CI:3.92～107.44,P<0.01)and thrombocytopenia(OR=8.74,95%CI:1.08～70.49,P<0.05)were significantly higher than those in non-neoadjuvant chemotherapy group;There was no significant difference between the two groups in descending to p T2(OR=0.71,95%CI:0.49～1.03,P>0.05),descending to p T3(OR=0.83,95%CI:0.48～1.43,P>0.05),descending to p T4(OR=0.86,95%CI:0.56～1.32,P>0.05)and lymph node positive(OR=0.67,95%CI:0.41～1.11,P>0.05);Infection(OR=0.65,95%CI:0.18～2.33,P>0.05),fever(OR=2.49,95%CI:0.07～88.46,P>0.05),nausea and vomiting(OR=2.49,95%CI:0.07 ～ 88.46,P>0.05),diarrhea(OR=1.23,95%CI:0.61～2.50,P>0.05)There was no significant difference in the adverse reactions of leucopenia(OR=8.20,95%CI:0.67～99.85,P>0.05)and rash(OR=3.34,95%CI:0.77～14.43,P>0.05).Conclusion:1.Neoadjuvant chemotherapy can effectively control the disease progression of myometrial invasive bladder cancer patients,reduce the risk of death and prolong the survival time;2.Neoadjuvant chemotherapy can preserve the bladder of more patients with myometrial invasive bladder cancer and improve their quality of life.