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Effects of intravesical BCG maintenance therapy duration on recurrence rate in high-risk non-muscle invasive bladder cancer (NMIBC): Systematic review and network meta-analysis according to EAU COVID-19 recommendations

 Young Joon Moon  ;  Kang Su Cho  ;  Jae Yong Jeong  ;  Doo Yong Chung  ;  Dong Hyuk Kang  ;  Hae Do Jung  ;  Joo Yong Lee 
 PLOS ONE, Vol.17(9) : e0273733, 2022-09 
Journal Title
Issue Date
Adjuvants, Immunologic ; Administration, Intravesical ; BCG Vaccine / therapeutic use ; Bayes Theorem ; COVID-19* ; Duration of Therapy ; Humans ; Mycobacterium bovis* ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local / drug therapy ; Network Meta-Analysis ; Pandemics ; Urinary Bladder Neoplasms* / drug therapy ; Urology*
Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the European Association of Urology (EAU) recommended that courses of intravesical bacillus Calmette-Guérin (BCG) therapy lasting more than 1 year could be safely terminated for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). Thus, we conducted a systematic review and network meta-analysis according to EAU's COVID-19 recommendations.

Materials and methods: A systematic review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We conducted a network meta-analysis of recurrence rate in patients with NMIBC receiving induction therapy (M0) and those receiving maintenance therapy lasting 1 year (M1) and more than 1 year (M2).

Results: Nineteen studies of 3,957 patients were included for the network meta-analysis. In a node-split forest plot using Bayesian Markov Chain Monte Carlo (MCMC) modeling, there were no differences between the M1 and M2 groups in recurrence rate [odds ratio (OR) 0.95 (0.73-1.2)]. However, recurrence rate in the M0 group was higher than that in the M1 [OR 1.9 (1.5-2.5)] and M2 [OR 2.0 (1.7-2.4)] groups. P-score tests using frequentist inference to rank the treatments in the network demonstrated that the therapy used in the M2 group (P-score 0.8701) was superior to that used in the M1 (P-score 0.6299) and M0 groups (P-score 0). In rank-probability tests using MCMC modeling, the M2 group showed the highest rank, followed by the M1 and M0 groups.

Conclusion: In the network meta-analysis, there were no differences between those receiving BCG maintenance therapies in terms of recurrence rate. In the rank tests, therapy lasting more than 1-year appears to be most effective. During the COVID-19 pandemic, 1-year maintenance therapy can be used, but after the COVID-19 pandemic, therapy lasting more than 1-year could be beneficial.
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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
Jeong, Jae Yong(정재용)
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
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