Three versus four cycles of neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and meta-analysis

Abstract

Objective

The optimal cycle of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) remains controversial. This study aimed to compare the efficacy of three and four cycles of NAC in the treatment of MIBC through a systematic review and meta-analysis of the literature.

Materials and Methods

Relevant studies were systematically collected and reviewed in PubMed, Medline, Embase, Web of Science Databases, and the Cochrane Library. Relative ratios (RRs), Hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to estimate outcome measures. Studies comparing the pathological response and prognosis of three versus four cycles of NAC for MIBC were included.

Results

Five studies were included in this meta-analysis, including 2190 patients, of whom 1016 underwent three cycles of NAC and 1174 underwent four cycles of NAC. All studies were retrospective cohort studies. We found that 4 cycles of NAC had significantly better cancer-specific survival than 3 cycles (HR = 1.31, 95%CI,1.03–1.67, p = 0.029). There was no significant difference in overall survival between patients who received 3 and 4 cycles of chemotherapy (HR = 1.18, 95%CI = 0.83–1.69, p = 0.345). Similarly, no significant difference was observed in pathological objective response (RR = 0.95, 95%CI= 0.81–1.11, p = 0.515) and complete response rates (RR = 0.87, 95%CI = 0.69–1.11, p = 0.256) in MIBC after 3 or 4 cycles of NAC.

Conclusions

Three and four cycles of NAC had similar pathological responses and prognosis for MIBC, although the cancer-specific survival rate of four cycles was better than that of three cycles.

KEY MESSAGES:

• The pathological response rate and overall survival of three and four cycles of neoadjuvant chemotherapy for muscle-invasive bladder cancer were similar.

• Four cycles of neoadjuvant chemotherapy may improve the cancer-specific survival of patients with muscle-invasive bladder cancer

• It is reasonable and feasible for clinicians to use three or four cycles of neoadjuvant chemotherapy.

Keywords:

• Urinary bladder neoplasms
• neoadjuvant therapy
• cisplatin
• systematic review
• meta-analysis

Authors’ contributions

Conception and design: YLW and YXS; Analysis and interpretation of the data: YLW, YXS, and CPQ; Drafting and revision of the paper: YLW and YXS; Revision of the paper: CLZ, YQD and TX; All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All the data generated or analyzed during the current study were obtained from the included studies.

Additional information

Funding

This research was supported by National Key Research and Development Program of China (2018YFA0902802), National Natural Science Foundation of China (82271877), and National Natural Science Foundation of China (82071777).