Meta-analysis Of Efficacy And Safety Of Intravesical Instillation Of Pirarubicin And Gemcitabine

Background:Intravesical instillation chemotherapy plays an important role in the treatment of superficial bladder tumors.There are many types of infusion drugs.Among them,pirarubicin and gemcitabine are widely used clinically,but the efficacy and adverse reactions of the two are still lacking evidence-based medicine.Objective:To evaluate the differences in the prevention of tumor recurrence and adverse reactions by intravesical chemotherapy with pirarubicin or gemcitabine after transurethral resection of NMIBC.Methods:The Chinese and English databases such as PubMed,The Cochrane Library,EMbase,CNKI,and Wanfang were searched through the computer,and randomized controlled trials and cohort studies of pirarubicin and gemcitabine infusion chemotherapy after TURBT were conducted.The main search term was “Urinary Bladder Neoplasms,Bladder Neoplasms,Bladder Cancer,Cancer of Bladder,Pirarubicin,Gemcitabine,Bladder Instillation”.The search period was Jianku until February 2018.Comparative inclusion and exclusion criteria Initial screening of the literature,data extraction,and then using RevMan5.3 software for meta-analysis to assess the difference in the prevention of bladder tumor recurrence and adverse reactions.Results:1.The basic situation of the literature was included: Eight Chinese articles were finally included.The total number of patients enrolled was 726,of which 361 were in the gemcitabine group(GEM group)and 365 were in the pirarubicin group(THP group).2.1 year recurrence rate of bladder tumors: The recurrence rate of bladder tumor in GEM group was lower than that in THP group(OR=3.15,95% CI(1.33,7.43),P=0.009).3.2 year recurrence rate of bladder tumor: The 2-year recurrence rate of bladder tumor in GEM group was lower than that in THP group(OR=2.28,95% CI(1.51,3.45),P<0.0001).4.Occurrence rate of bladder irritation: In contrast to the THP group,bladder irritation signs were less frequent in the GEM group.(OR=2.05,95% CI(1.40,2.98),P=0.0002).5.Hematuria incidence: There was no significant difference in hematuria between the THP group and the GEM group.(OR=1.84,95% CI(0.95,3.55),P=0.07).6.Gastrointestinal reaction rate: Compared with the THP group,there was less gastrointestinal adverse reactions in the GEM group(OR=5.85,95% CI(2.37,14.42),P=0.0001).7.The incidence of liver and kidney damage: There was no significant difference between the GEM group and the THP group in patients with liver and kidney function impairment(OR=2.71,95% CI(0.96,7.62),P=0.06).Conclusious:1.Intravesical instillation of pirarubicin and gemcitabine is safe and effective,but gemcitabine is more effective in preventing recurrence of bladder cancer after one year or two years.2.In terms of adverse reactions,gemcitabine showed less bladder irritation and gastrointestinal discomfort than pirarubicin,and there was no significant difference in hematuria and liver and kidney function between the two groups.