Device-assisted intravesical chemotherapy versus bacillus Calmette–Guerin for intermediate or high-risk non-muscle invasive bladder cancer: a systematic reviewer and meta-analysis

Purpose To investigate the effectiveness and safety of device-assisted intravesical chemotherapy compared to Bacillus Calmette–Guerin (BCG) in the treatment of patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). Methods In February 2023, a systematic search was cond...

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Published in:International urology and nephrology 2024-01, Vol.56 (1), p.103-120
Main Authors: You, Chengyu, Li, Qingchao, Qing, Liangliang, Li, Rongxin, Wang, Yanan, Cheng, Long, Dong, Zhilong
Format: Article
Language:English
Subjects:
Adverse events
Bladder cancer
Chemotherapy
Fever
Hematuria
Invasiveness
Medicine
Medicine & Public Health
Meta-analysis
Nephrology
Statistical analysis
Survival
Urology
Urology - Original Paper
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Summary:Purpose To investigate the effectiveness and safety of device-assisted intravesical chemotherapy compared to Bacillus Calmette–Guerin (BCG) in the treatment of patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). Methods In February 2023, a systematic search was conducted on the PubMed, Cochrane, and Embase databases. Following the PRISMA guidelines, a systematic review and meta-analysis of the primary outcomes of interest were performed. The review was prospectively registered on PROSPERO under the registration number CRD42023398559. Results A total of 10 studies involving 1160 patients were included. The results of the meta-analysis showed that compared to BCG, device-assisted chemotherapy had a lower recurrence rate (OR: 0.63, 95% CI: 0.48–0.84, p  = 0.001), longer recurrence-free survival (OR: 0.64, 95% CI: 0.47–0.88, p  = 0.006), and lower incidence of fever (OR: 0.18, 95% CI: 0.08–0.44, p  = 0.0002). However, no significant differences were observed between the two groups in terms of progression, overall survival, progression-free survival, disease-free survival, overall adverse events, serious adverse events, hematuria, allergy, and general discomfort. Subgroup analysis revealed that neither chemohyperthermia (CHT) nor electromotive drug administration (EMDA) showed statistically significant differences in oncological outcomes compared to BCG. Regarding adverse events, both CHT and EMDA groups showed lower rates of fever compared to the BCG group (OR: 0.26, 95% CI: 0.10–0.67, p  = 0.005, and OR: 0.14, 95% CI: 0.05–0.37, p  
ISSN:1573-2584
0301-1623
1573-2584
DOI:10.1007/s11255-023-03765-0