Bladder Cancer - Volume 7, issue 2

Authors: Veskimae, Erik | Subbarayan, Selvarani | Campi, Riccardo | Carron, Domitille | Omar, Muhammad Imran | Yuan, Cathy | Dimitropoulos, Konstantinos | Van Hemelrijck, Mieke | Bryan, Richard T. | N’Dow, James | Babjuk, Marek | Alfred Witjes, J. | Sylvester, Richard | MacLennan, Steven

Article Type: Systematic Review

Abstract: BACKGROUND: Heterogenous outcome reporting in non-muscle-invasive bladder cancer (NMIBC) effectiveness trials of adjuvant treatment after transurethral resection (TURBT) has been noted in systematic reviews (SRs). This hinders comparing results across trials, combining them in meta-analyses, and evidence-based decision-making for patients and clinicians. OBJECTIVE: We aimed to systematically review the extent of reporting and definition heterogeneity. METHODS: We included randomized controlled trials (RCTs) identified from SRs comparing adjuvant treatments after TURBT or TURBT alone in patients with NMIBC (with or without carcinoma in situ ) published between 2000–2020. Abstracts and full texts were screened independently by two …reviewers. Data were extracted by one reviewer and checked by another. RESULTS: We screened 807 abstracts; from 15 SRs, 57 RCTs were included. Verbatim outcome names were coded to standard outcome names and organised using the Williamson and Clarke taxonomy. Recurrence (98%), progression (74%), treatment response (in CIS studies) (40%), and adverse events (77%) were frequently reported across studies. However, overall (33%) and cancer-specific (33%) survival, treatment completion (17%) and treatment change (37%) were less often reported. Quality of Life (3%) and economic outcomes (2%) were rarely reported. Heterogeneity was evident throughout, particularly in the definitions of progression and recurrence, and how CIS patients were handled in the analysis of studies with predominantly papillary patients, highlighting further issues with the definition of recurrence and progression vs treatment response for CIS patients. Data reporting was also inconsistent, with some trials reporting event rates at various time-points and others reporting time-to-event with or without Hazard Ratios. Adverse events were inconsistently reported. QoL data was absent in most trials. CONCLUSIONS: Heterogenous outcome reporting is evident in NMIBC effectiveness trials. This has profound implications for meta-analyses, SRs and evidence-based treatment decisions. A core outcome set is required to reduce heterogeneity. PATIENT SUMMARY: This systematic review found inconsistencies in outcome definitions and reporting, pointing out the urgent need for a core outcome set to help improve evidence-based treatment decisions. Show more

Keywords: Outcome reporting heterogeneity, core outcome sets, non-muscle-invasive bladder cancer (NMIBC), TURBT, systematic review

DOI: 10.3233/BLC-201510

Citation: Bladder Cancer, vol. 7, no. 2, pp. 221-241, 2021

Authors: Kokorovic, Andrea | Westerman, Mary E. | Krause, Kate | Hernandez, Mike | Brooks, Nathan | Dinney, Colin P.N. | Kamat, Ashish M. | Navai, Neema

Article Type: Systematic Review

Abstract: BACKGROUND: The optimal management of non-invasive (mucosal and/or ductal) urothelial carcinoma of the prostate remains elusive and there is a paucity of data to guide treatment. OBJECTIVE: Our objective was to systematically review and synthesize treatment responses to conservative management of non-invasive prostatic urothelial carcinoma using intravesical therapy. METHODS: A systematic literature search using MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science databases from inception to November 2019 was performed. Risk of bias assessment was performed using the Newcastle-Ottawa scale for non-randomised studies. Pooled estimates of complete response in the bladder and prostate and prostate …only were performed using a random effects model. Pre-specified subgroup analyses were generated to assess differences in complete responses for: BCG therapy vs other agents, ductal vs mucosal involvement, CIS vs papillary tumors and TURP vs no TURP. RESULTS: Nine studies including 175 patients were identified for inclusion in the systematic review and meta-analysis. All were retrospective case series and most evaluated response to BCG therapy. The pooled global complete response rate for intravesical therapy was 60%(95%CI: 0.48, 0.72), and for prostate 88%(95%CI: 0.81, 0.96). Pre-specified analyses did not demonstrate statistically significant differences between subgroups of interest. CONCLUSIONS: Management of non-invasive prostatic urothelial carcinoma using intravesical therapy yields satisfactory results. Caution should be taken in treating patients with papillary tumors and ductal involvement, as data for these populations is limited. TURP may not improve efficacy, but is required for staging. Current recommendations are based on low quality evidence, and further research is warranted. Show more

Keywords: Urothelial carcinoma, prostatic urothelial carcinoma, BCG treatment, conservative management, intravesical therapy

DOI: 10.3233/BLC-200404

Citation: Bladder Cancer, vol. 7, no. 2, pp. 243-252, 2021

Authors: Soloway, Mark S.

Article Type: Case Report

DOI: 10.3233/BLC-219605

Citation: Bladder Cancer, vol. 7, no. 2, pp. 253-255, 2021

Authors: Agarwal, Piyush K. | Sternberg, Cora N.

Article Type: Other

DOI: 10.3233/BLC-200018

Citation: Bladder Cancer, vol. 7, no. 2, pp. 257-260, 2021