Low-dose And Standard-dose BCG Prevent Recurrence And Safety Of Non-muscle Invasive Bladder Cancer META Analysis

Objective: The purpose of this study was to conduct a systematic review of a large number of high-quality randomized controlled clinical trials to study,to explore the optimal dose of BCG bladder infusion treatment of bladder cancer provide a reliable scientific basis.Methods :According to the principle of evidence-based medicine,Cochrane systematic reviews were used to search the literature from Pubmed,Embase,Cochrane,web of science,CNKI,Wanfang database(from library to July 1,2017)The terms "Bladder Cancer","Vaccine,BCG","Bladder Instillation","Disease Progressions","randomized" and all corresponding free words,the Chinese search terms are "bladder cancer","bladder perfusion"," BCG "," disease progression." The incidence of bladder cancer recurrence,bladder irritation,hematuria and disease progression were included in the study.According to the established inclusion and exclusion criteria,the selected articles were screened and the quality of the included articles was evaluated.Finally,seven randomized controlled studies that met the inclusion criteria were conducted using software Rev Man5.3 A meta-analysis of the extracted relevant information.Results: A total of 2415 patients were enrolled in the study,including 1199 patients receiving low-dose BCG and 1216 patients receiving standard-dose BCG.BCG in the low-dose group was less effective in preventing recurrence(OR = 1.19;95% CI,1.00-1.40;P = 0.05;I2 = 0)(OR = 0.40;95% CI,0.23-0.71;P = 0.002;I2 = 44),hematuria(OR = 0.40;95% CI,0.18-0.90;P = 0.03;I2 = 0)were lower than the standard dose group,the difference was statistically significant.Although included in this study were high-quality randomized controlled studies,literature retrieval,systematic reviews,and results that followed a scientifically sound approach,the limited number of articles and subjects included in this study,So this study also has some limitations.Conclusions:1,low-dose group and standard dose of BCG bladder irrigation on bladder cancer recurrence rate and disease progression has no significant difference;2,low-dose group of bladder irritation and hematuria symptoms compared with the standard dose group was significantly lower.Bladder cancer patients given low-dose BCG infusion therapy,the prevention of disease recurrence and disease progression in patients with the same effect as the standard dose of treatment patients with the same prognosis;the same time,low-dose BCG in patients with adverse reactions than the standard dose of intravesical instillation decreased.Therefore,low dose and standard dose of BCG compared with bladder irrigation,similar efficacy,lower incidence of adverse reactions,and thus more suitable for clinical bladder cancer patients with bladder irrigation.