A Meta-analysis Of Second Transurethral Resection For Treatment Of Superficial Bladd Cancer

Objective:To evaluate the efficacy and safety for second TUR ,compared with traditional TUR-BT,on recurrence rate and progression rate.To provide the best evidence for clinical treatment decisions and future research.Methods:Searches were applied to following electronic database:Medline; Pubmed/Medline database(1980.1-2010.12),OVID(1980.1-2010.12),EMBASE(1980.1-2010.12),CBM(1980.1-2010.12),CNKI(1980.1-2010.12),CEBM\CCD,Cochrane Liberaray. Meanwhile, Hand search was applied in recent Chinese J Urol,Journal of Clinial Urology and other four journals.Randomized controlled trials(RCTs) and Controlled clinial trial comparing Second TUR with No second TUR for superficial bladder cancer were included. Controlled trial should be used without limiting language or only used blinding participant. Date were extracted independently by two Reviewer.The methodological quality of trails was assessed by the jada-Score. Trials were assessed for quality according to the randomization,allocation concealment,blinding,loss to follow- up and baseline, and graded their methodological quality according to the Cochrane handbook for systematic reviews of interventions.Meta- analysis was performed using Revman5.0 software provided by the Cochlane collaboration. For dichotomous data,results were expressed as Odds Ratio(OR) and 95% confidence internals(CI). After heterogeneity test,data without heterogeneity could be pooled using fixed effect model, and those with heterogeneity could be solved by randomized effect model.Oweing to moderate possibility of publication bias in limited included studies,the funnel polts was not drawn. Results:Following a thorugh search,263 literatures were included.After reading the title and summary carefully,241 articles were excluded which did not meet the requirements.18 papers were excluded after reading the full text of the remaining 22 documents.Finally,four trials involving 775 patients were included.One trial was randomized controlled trial and other three were clinical controlled trials.Most trials were of poor quality.According to the results of meta-analysis:(1)When it comes to superficial bladder cancer,the OR and its 95% CI of total recurrence rate for second TUR were OR0.34 and 95%CI(0.25,0.46).(2) When it comes to superficial bladder cancer,the OR and its 95% CI of total progression rate for second TUR were OR 0.25 and 95%CI(0.12,0.5).Conclusion:Based on the above analysis results,second TUR in patients with superficial bladder cancer can reduce the incidence of tumor recurrence and disease progression more effectively,compared with TUR-BT alone.Howerer,due to small number of included studies and the few high-quality literature,selection bias,performance bias and publication bias possibility are likely to affect the reliability of the results.We should be cautious about these conclusions.We expect best evidence from more high quality double blind randomized controlled trials.