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      Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

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          Abstract

          Objective

          We conducted a systematic review and meta-analysis to assess the available literature regarding the surgical and oncologic outcomes of patients undergoing salvage radical cystectomy (SV-RC) for recurrence or failure of bladder sparing therapy (BST) for muscle-invasive bladder cancer (MIBC).

          Methods

          We searched MEDLINE (PubMed), EMBASE and Google Scholar databases in May 2020. We included all studies of patients with ≥ cT2N0/xM0 bladder cancer that were eligible for all treatment modalities at the time of treatment decision who underwent BST including radiotherapy (RTX). A meta-analysis was conducted to calculate the pooled rate of several variables associated with an increased need for SV-RC. Study quality and risk of bias were assessed using MINORS criteria.

          Results

          73 studies comprising 9110 patients were eligible for the meta-analysis. Weighted mean follow-up time was 61.1 months (range 12–144). The pooled rate of non-response to BST and local recurrence after BST, the two primary reasons for SV-RC, was 15.5% and 28.7%, respectively. The pooled rate of SV-RC was 19.2% for studies with a follow-up longer than 5 years. Only three studies provided a thorough report of complication rates after SV-RC. The overall complication rate ranged between 67 and 72% with a 30-day mortality rate of 0–8.8%. The pooled rates of 5 and 10-year disease-free survival after SV-RC were 54.3% and 45.6%, respectively.

          Conclusion

          Approximately one-fifth of patients treated with BST with a curative intent eventually require SV-RC. This procedure carries a proportionally high rate of complications and is usually accompanied by an incontinent urinary diversion.

          Electronic supplementary material

          The online version of this article (10.1007/s00345-020-03436-0) contains supplementary material, which is available to authorized users.

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          Most cited references115

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          Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

          D F Stroup, J A Berlin, S C Morton … (2000)
          Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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            Methodological index for non-randomized studies (minors): development and validation of a new instrument.

            Karem Slim, Emile Nini, Damien Forestier … (2003)
            Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non-randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta-analysis. The aim of the present study was to develop and validate such an instrument. After an initial conceptualization phase of a methodological index for non-randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialties for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter-reviewer agreement, test-retest reliability at 2 months, internal consistency reliability and external validity. The final version of MINORS contained 12 items, the first eight being specifically for non-comparative studies. Reliability was established on the basis of good inter-reviewer agreement, high test-retest reliability by the kappa-coefficient and good internal consistency by a high Cronbach's alpha-coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials. MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.
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              Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients.

              D Thangathurai, Fady M Mikhail, D. Raghavan … (2001)
              To evaluate our long-term experience with patients treated uniformly with radical cystectomy and pelvic lymph node dissection for invasive bladder cancer and to describe the association of the primary bladder tumor stage and regional lymph node status with clinical outcomes. All patients undergoing radical cystectomy with bilateral pelvic iliac lymphadenectomy, with the intent to cure, for transitional-cell carcinoma of the bladder between July 1971 and December 1997, with or without adjuvant radiation or chemotherapy, were evaluated. The clinical course, pathologic characteristics, and long-term clinical outcomes were evaluated in this group of patients. A total of 1,054 patients (843 men [80%] and 211 women) with a median age of 66 years (range, 22 to 93 years) were uniformly treated. Median follow-up was 10.2 years (range, 0 to 28 years). There were 27 (2.5%) perioperative deaths, with a total of 292 (28%) early complications. Overall recurrence-free survival at 5 and 10 years for the entire cohort was 68% and 66%, respectively. The 5- and 10-year recurrence-free survival for patients with organ-confined, lymph node-negative tumors was 92% and 86% for P0 disease, 91% and 89% for Pis, 79% and 74% for Pa, and 83% and 78% for P1 tumors, respectively. Patients with muscle invasive (P2 and P3a), lymph node-negative tumors had 89% and 87% and 78% and 76% 5- and 10-year recurrence-free survival, respectively. Patients with nonorgan-confined (P3b, P4), lymph node-negative tumors demonstrated a significantly higher probability of recurrence compared with those with organ-confined bladder cancers (P <.001). The 5- and 10-year recurrence-free survival for P3b tumors was 62% and 61%, and for P4 tumors was 50% and 45%, respectively. A total of 246 patients (24%) had lymph node tumor involvement. The 5- and 10-year recurrence-free survival for these patients was 35%, and 34%, respectively, which was significantly lower than for patients without lymph node involvement (P <.001). Patients could also be stratified by the number of lymph nodes involved and by the extent of the primary bladder tumor (p stage). Patients with fewer than five positive lymph nodes, and whose p stage was organ-confined had significantly improved survival rates. Bladder cancer recurred in 311 patients (30%). The median time to recurrence among those patients in whom the cancer recurred was 12 months (range, 0.04 to 11.1 years). In 234 patients (22%) there was a distant recurrence, and in 77 patients (7%) there was a local (pelvic) recurrence. These data from a large group of patients support the aggressive surgical management of invasive bladder cancer. Excellent long-term survival can be achieved with a low incidence of pelvic recurrence.
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                Author and article information

                Contributors
                Shahrokh F. Shariat: shahrokh.shariat@meduniwien.ac.at
                Journal
                Journal ID (nlm-ta): World J Urol
                Journal ID (iso-abbrev): World J Urol
                Title: World Journal of Urology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0724-4983
                ISSN (Electronic): 1433-8726
                Publication date (Electronic): 29 September 2020
                Publication date PMC-release: 29 September 2020
                Publication date (Print): 2021
                Volume: 39
                Issue: 6
                Pages: 1757-1768
                Affiliations
                [1 ]GRID grid.411904.9, ISNI 0000 0004 0520 9719, Department of Urology, Comprehensive Cancer Center, , Vienna General Hospital, Medical University of Vienna, ; Währinger Gürtel 18-20, 1090 Vienna, Austria
                [2 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Urology, , University Medical Center Hamburg-Eppendorf, ; Hamburg, Germany
                [3 ]GRID grid.411167.4, ISNI 0000 0004 1765 1600, Department of Urology, , University Hospital of Tours, ; Tours, France
                [4 ]GRID grid.415280.a, ISNI 0000 0004 0402 3867, Department of Urology, , King Fahad Specialist Hospital, ; Dammam, Saudi Arabia
                [5 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Research Center for Evidence Based Medicine, , Tabriz University of Medical Sciences, ; Tabriz, Iran
                [6 ]GRID grid.448878.f, ISNI 0000 0001 2288 8774, Institute for Urology and Reproductive Health, , Sechenov University, ; Moscow, Russia
                [7 ]GRID grid.411898.d, ISNI 0000 0001 0661 2073, Department of Urology, , The Jikei University School of Medicine, ; Tokyo, Japan
                [8 ]GRID grid.413005.3, ISNI 0000 0004 1760 6850, Division of Urology, Department of Surgical Sciences, , San Giovanni Battista Hospital, University of Studies of Torino, ; Turin, Italy
                [9 ]GRID grid.5386.8, ISNI 000000041936877X, Department of Urology, , Weill Cornell Medical College, ; New York, NY USA
                [10 ]GRID grid.267313.2, ISNI 0000 0000 9482 7121, Department of Urology, , University of Texas Southwestern, ; Dallas, TX USA
                [11 ]GRID grid.487248.5, Karl Landsteiner Institute of Urology and Andrology, ; Vienna, Austria
                [12 ]GRID grid.466642.4, ISNI 0000 0004 0646 1238, European Association of Urology Research Foundation, ; Arnhem, The Netherlands
                Author information
                http://orcid.org/0000-0002-7114-0508
                Article
                Publisher ID: 3436
                DOI: 10.1007/s00345-020-03436-0
                PMC ID: 8217031
                PubMed ID: 32995918
                SO-VID: 693e53cd-bc1d-4c0b-a32e-cf3a6eed34ec
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 13 July 2020
                Date accepted : 31 August 2020
                Funding
                Funded by: Medical University of Vienna
                Open Access :

                Open access funding provided by Medical University of Vienna.

                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                ScienceOpen disciplines: Urology
                Keywords: mibc,bladder sparing treatment,bladder,cancer,salvage cystectomy,radiotherapy
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: mibc, bladder sparing treatment, bladder, cancer, salvage cystectomy, radiotherapy

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