Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Export

@article{citeulike:5786582, abstract = {BACKGROUND: Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease. METHODS: We analysed updated data for 2688 individual patients from ten available randomised trials. FINDINGS: Platinum-based combination chemotherapy showed a significant benefit to overall survival (combined hazard ratio [HR] 0.87 [95\% CI 0.78-0.98, p=0.016]; 13\% reduction in risk of death; 5\% absolute benefit at 5 years [1-7]; overall survival increased from 45\% to 50\%). This effect was observed irrespective of the type of local treatment, and did not vary between subgroups of patients. The HR for all trials, including those using single-agent cisplatin, tended to favour neoadjuvant chemotherapy (HR=0.91, 95\% CI 0.83-1.01) although this tendency was not significant (p=0.084). Although platinum based combination chemotherapy was beneficial, there was no evidence to support the use of single-agent platinum; indeed, there was a significant difference in the effect between these groups of trials (p=0.044). INTERPRETATION: This improvement in survival encourages the use of platinum-based combination chemotherapy for patients with invasive bladder cancer.}, author = {{Advanced Bladder Cancer Meta-analysis Collaboration}}, citeulike-article-id = {5786582}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/12801735}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=12801735}, day = {7}, issn = {0140-6736}, journal = {Lancet}, keywords = {bladder, cancer, chemo, invasive, neo}, month = {June}, number = {9373}, pages = {1927--1934}, posted-at = {2009-09-15 14:41:05}, priority = {2}, title = {Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/12801735}, volume = {361}, year = {2003} }

TY - JOUR ID - citeulike:5786582 L3 - citeulike-article-id:5786582 N2 - BACKGROUND: Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease. METHODS: We analysed updated data for 2688 individual patients from ten available randomised trials. FINDINGS: Platinum-based combination chemotherapy showed a significant benefit to overall survival (combined hazard ratio [HR] 0.87 [95% CI 0.78-0.98, p=0.016]; 13% reduction in risk of death; 5% absolute benefit at 5 years [1-7]; overall survival increased from 45% to 50%). This effect was observed irrespective of the type of local treatment, and did not vary between subgroups of patients. The HR for all trials, including those using single-agent cisplatin, tended to favour neoadjuvant chemotherapy (HR=0.91, 95% CI 0.83-1.01) although this tendency was not significant (p=0.084). Although platinum based combination chemotherapy was beneficial, there was no evidence to support the use of single-agent platinum; indeed, there was a significant difference in the effect between these groups of trials (p=0.044). INTERPRETATION: This improvement in survival encourages the use of platinum-based combination chemotherapy for patients with invasive bladder cancer. IS - 9373 JF - Lancet SN - 0140-6736 EP - 1934 TI - Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. VL - 361 SP - 1927 KW - bladder KW - cancer KW - chemo KW - invasive KW - neo PY - 2003/06/07/ UR - http://view.ncbi.nlm.nih.gov/pubmed/12801735 ER -