THE EFFECTS OF NEOADJUVANT AND ADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED MUSCLE-INVASIVE BLADDER CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Objective: A systematic and meta-analysis from individual patient time-to-event data were performed in order to assess the benefit of neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) without additional G-CSF or immunotherapy or targeted therapy in the treatments of patients with locally advanced muscle-invasive bladder cancer (MIBC). Methods: Randomized controlled trials (RCTs) comparing the effect any pair of treatments (i.e., NAC, AC, and local treatment) on locally advanced MIBC cancer were identified from MEDLINE, SCOPUS, and WHO-ICTRP databases. Overall survival (OS) probabilities and times were extracted from Kaplan-Meier (KM) curves using Digitizer program and converted to individual patient time-to-event data. A one-stage mixed effect survival model was applied to estimate the median OS and hazard ratio (HR). Results: A total of 9 RCTs (1,415 patients) were selected. The median OS of NAC and AC were longer than local treatment (52.9 vs 43.0 months) and (61.9 vs 54.3 months) with HR (95% CI) of 0.83 (0.71, 0.97) and 0.89 (0.64, 1.23), respectively. Conclusion: NAC and AC could be beneficial in patients with locally advanced MIBC.