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Adjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials
근침윤성 방광암에 대한 수술 후 보조 항암치료: 체계적 문헌고찰 및 무작위배정 임상시험들에 대한 네트워크 메타분석

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Authors
김형석
Advisor
구자현
Major
의과대학 의학과
Issue Date
2018-02
Publisher
서울대학교 대학원
Keywords
Urinary bladder neoplasmscystectomyadjuvant chemotherapysystematic reviewnetwork meta-analysis
Description
학위논문 (박사)-- 서울대학교 대학원 : 의과대학 의학과, 2018. 2. 구자현.
Abstract
95% CI, 0.68-0.92) than RC alone. In the network meta-analysis, the gemcitabine/cisplatin/paclitaxel (GCP) combination was the only ACH regimen associated with significant improvement in both the PFS (HR, 0.38
95% CrI, 0.25-0.58) and OS (HR, 0.38
95% CrI, 0.22-0.65).

Conclusions: ACH following RC for MIBC may therefore contribute to improved PFS and OS. In particular, the GCP combination may be the optimal ACH regimen for improving postoperative survival outcomes. Additional well-designed, large scale, prospective, randomized trials are still required to establish the optimal ACH regimen in MIBC patients.
Objective: Although adjuvant chemotherapy (ACH) is widely used in clinical practice for the management of muscle-invasive bladder cancer (MIBC), a consensus has yet to be established on which ACH regimen is the most effective for improving postoperative survival. In this study, we aimed to systematically assess the optimal ACH regimen for improving survival outcomes in patients treated with radical cystectomy (RC) for MIBC.

Materials and Methods: A comprehensive literature search was conducted in the PubMed, Embase, and the Cochrane Library databases for all articles published until December 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The study end-points were progression-free survival (PFS) and overall survival (OS). A direct pairwise meta-analysis was conducted by pooling the studies that compared RC with ACH and RC alone, and the results are presented as a pooled hazard ratio (HR) with a 95% confidence interval (CI). A Bayesian network meta-analysis was adopted for indirect comparisons among various ACH regimens, and the outcomes are presented as HRs with 95% credible intervals (CrI).

Results: The eleven randomized controlled trials ultimately selected for the current analysis comprised of 1,546 patients with 49 to 327 subjects per study. Based on the pairwise meta-analysis, the use of ACH showed significantly better PFS (HR, 0.64
95% CI, 0.49-0.85) and OS (HR, 0.79
Language
English
URI
https://hdl.handle.net/10371/141002
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Theses (Ph.D. / Sc.D._의학과)
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