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Effect of neoadjuvant chemotherapy on overall survival of patients with T2-4aN0M0 bladder cancer: A systematic review and meta-analysis according to EAU COVID-19 recommendation

 Dong Hyuk Kang  ;  Kang Su Cho  ;  Young Joon Moon  ;  Doo Yong Chung  ;  Hae Do Jung  ;  Joo Yong Lee 
 PLOS ONE, Vol.17(4) : e0267410, 2022-04 
Journal Title
Issue Date
COVID-19* ; Cystectomy ; Female ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Invasiveness ; Pandemics ; Retrospective Studies ; Urinary Bladder Neoplasms* / drug therapy ; Urinary Bladder Neoplasms* / surgery ; Urology*
Purpose: In the context of the COVID-19 outbreak, the European Association of Urology (EAU) guidelines Rapid Reaction Group provided recommendations to manage muscle invasive bladder cancer (MIBC) based on priority levels: neoadjuvant chemotherapy (NAC) should be avoided for patients with T2-3N0M0 MIBC. This meta-analysis aims to evaluate the efficacy of NAC compared with radical cystectomy (RC) alone in improving the overall survival (OS) of patients with T2-4aN0M0 MIBC.

Materials and methods: A systematic review was performed according to the PRISMA guidelines. The PubMed/Medline, EMBASE, and Cochrane Library databases were searched. The primary outcome was OS of patients with T2-4aN0M0 MIBC, and the secondary outcome was OS of patients with only T2N0M0 MIBC.

Results: Eight studies were included in this meta-analysis. Overall, the quality of all studies was relatively high, and little publication bias was demonstrated. The OS was significantly better in the NAC with RC group than in RC alone (HR, 0.79; 95% CI, 0.68-0.92; p = 0.002). A subgroup analysis was performed on only patients with T2N0M0 MIBC, and five studies were included. There was no difference in the OS between the NAC with RC and the RC alone groups (HR, 0.83; 95% CI, 0.69-1.01 p = 0.06).

Conclusions: As recommended by the EAU guidelines Rapid Reaction Group, patients with T2N0M0 MIBC should strongly consider omitting NAC until the end of the COVID-19 pandemic. Whether to omit NAC in T3-4aN0M0 MIBC needs further discussion, and studies targeting only T2-3N0M0 MIBC are expected to proceed further.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Moon, Young Joon(문영준)
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
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