Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis
⚑Needs review
Phase meta-analysisN = 2,688
Population
2688 patients with invasive bladder cancer from ten randomised trials (updated individual patient data)
Design
Systematic review and meta-analysis of updated individual patient data from ten available randomised trials of neoadjuvant chemotherapy in invasive bladder cancer. Overall survival was analysed as a combined hazard ratio, separately for trials of platinum-based combination chemotherapy and for all trials including those using single-agent cisplatin.
Arms
No neoadjuvant chemotherapy(control): Local treatment without neoadjuvant chemotherapy (control arms of the trials)
Platinum-based combination chemotherapy(experimental): Neoadjuvant platinum-based combination chemotherapy before local treatment
People
Advanced Bladder Cancer Meta-analysis Collaboration, Advanced Bladder Cancer Meta-analysis Collaboration
OSHR 0.87 (95% CI 0.78–0.98)Δ 60-month OS+5 pointsOSHR 0.91 (95% CI 0.83–1.01)
Show the numbers
Results reported for Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis
Endpoint
Analysis
Platinum-based combination chemotherapy
No neoadjuvant chemotherapy
Effect
OSTrials of platinum-based combination chemotherapy
primaryAdvanced 2003
50% at 5 y
45% at 5 y
HR 0.87 (95% CI 0.78–0.98)P=0.016The abstract describes a 13% reduction in the risk of death and a 5% absolute benefit at 5 years (interval printed as [1-7], not labelled in the abstract). Single-agent platinum: no supporting evidence in the abstract, with a significant difference in effect between the two groups of trials (p=0.044).
OSAll ten trials, including those using single-agent cisplatin
primaryAdvanced 2003
—
—
HR 0.91 (95% CI 0.83–1.01)P=0.084
Results reported for Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis
Endpoint
Analysis
Platinum-based combination chemotherapy
No neoadjuvant chemotherapy
Effect
OSTrials of platinum-based combination chemotherapy
primaryAdvanced 2003
50% at 5 y
45% at 5 y
HR 0.87 (95% CI 0.78–0.98)P=0.016The abstract describes a 13% reduction in the risk of death and a 5% absolute benefit at 5 years (interval printed as [1-7], not labelled in the abstract). Single-agent platinum: no supporting evidence in the abstract, with a significant difference in effect between the two groups of trials (p=0.044).
OSAll ten trials, including those using single-agent cisplatin
primaryAdvanced 2003
—
—
HR 0.91 (95% CI 0.83–1.01)P=0.084
Hazard ratio (95% CI) by endpoint. Values below 1 favour the experimental arm.Data table
Advanced Bladder Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet. 2003;361(9373):1927-34.