#1273

Hyperthermia Intravesical Chemotherapy vs. Bacillus Calmette-Guérin instillation and Mitomycin C Perfusion for Non-muscle-invasive Bladder Cancer: A Network Meta-analysis

X. Gong¹, N. Zeng¹

¹Wuhan, China

Introduction:

With the shortage of bacillus Calmette-Guérin (BCG) vaccine, it is urgent to find an alternative to BCG instillation, which is the most commonly used adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC) patients after transurethral resection of bladder tumor treatment (TURBt) to delay tumor recurrence. Hyperthermia intra-vesical chemotherapy (HIVEC) with mitomycin C (MMC) is a good choice for NMIBC patients as an adjuvant treatment after TURBt. We aim to compare HIVEC with BCG instillation in the preventive efficacy of bladder tumor recurrence and progression by a network meta-analysis (NMA) taking MMC instillation and TURBt as the attached comparators.

Material and methods:

PubMed (Medline), Ovid (Embase) and Cochrane Library were searched, and the network meta-analysis process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Articles with BCG unresponsible patients and combined therapies were excluded. Evaluation was based on the recurrence free survival (RFS) and progression free survival (PFS).

Results:

72 clinical trials were eligible. A Bayesian consistency network model was generated under a random-effects model. HIVEC played a nonsignificant 22% relative reduction in bladder tumor recurrence compared with BCG instillation (HIVEC vs. BCG: HR 0.78, 95% credible interval [CrI] 0.55–1.08), and a nonsignificant higher risk of bladder tumor progression (BCG vs. HIVEC: HR 0.77, 95% credible interval [CrI] 0.22–3.03). Notably, in subgroup analysis of RFS, HIVEC plays significant 30% relative reduction compared with BCG perfusion (HR 0.70, 95% credible interval [CrI] 0.48–0.99) for patient groups with a higher portion of male. For articles with longer follow-up (median follow-up ≥ 2.5yr), HIVEC shows significant efficacy in the tumor recurrence prevention (HR 0.38, 95% credible interval [CrI] 0.17–0.85).