Adult urologyIntravesical bacille calmette-guérin versus mitomycin c in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression☆
Section snippets
Material and methods
For the methods of data extraction, statistical analysis, and reporting, the rules and principles of the Cochrane Collaboration Reviews7 and those published in a previous report3 on the relative effects of BCG and MMC against superficial bladder cancer recurrence were applied as far as was possible and feasible.
Results
In nine eligible clinical trials with a total of 2410 patients, the sample size range of the included trials was 91 to 418 patients. In total, 1277 patients were treated with BCG and compared with 1133 patients treated with MMC. Seven of these studies were prospective clinical trials and two were retrospective observational cohort studies with concurrent groups (Table I). The overall median follow-up was 26 months (mean 28.6 ± 16 SD, range 11.5 to 50.4). The mean follow-up duration was not
Comment
Published reports have a paucity of valid data on the effect of intravesical therapy on the progression of superficial bladder cancer4 probably because of the relatively small numbers of high-risk patients entered into clinical trials. Furthermore, many individual trials had low power to detect medically plausible differences between two treatment regimens, especially if both regimens were of valid efficacy. One way to overcome these problems is to perform a combined analysis of available
Conclusions
The evidence from this formal meta-analysis suggests that adjuvant intravesical BCG with maintenance treatment is effective and is superior to intravesical MMC chemotherapy for the prophylaxis of tumor progression in superficial bladder cancer. To patients with a risk of progression, adjuvant intravesical BCG therapy with maintenance should be offered as the treatment of choice.
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This study was supported by an educational grant from Aventis Pasteur S. A., Lyon, France.