Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer: Does the current quality of evidence justify definitive conclusions?

Marian S. Wettstein, Jasjit K. Rooprai, Clinsy Pazhepurackel, Christopher J.D. Wallis, Zachary Klaassen, Elizabeth M. Uleryk, Thomas Hermanns, Neil E. Fleshner, Alexandre R. Zlotta, Girish S. Kulkarni

Research output: Contribution to journalReview article

Abstract

Objectives To systematically review and meta-analyze the current literature in a methodologically rigorous and transparent manner for quantitative evidence on survival outcomes among patients diagnosed with muscle-invasive bladder cancer that were treated by either trimodal therapy or radical cystectomy. Materials and methods MEDLINE, EMBASE, CENTRAL were systematically searched for comparative observational studies reporting disease-specific survival and/or overall survival on adult patients diagnosed with localized muscle-invasive bladder cancer that were exposed to either trimodal therapy or radical cystectomy. Studies qualified for meta-analysis (random effects model) if they were not at critical risk of bias (RoB). Results The literature search identified 12 eligible studies. Three (all rated as “moderate RoB”) out of 6 studies reporting on disease-specific survival qualified for quantitative analysis and yielded a pooled hazard ratio (trimodal therapy versus radical cystectomy) of 1.39 (95% confidence interval: 1.03–1.88). Four (mainly rated as “serious RoB”) out of 12 studies were included in the meta-analysis of overall survival and estimated a hazard ratio of 1.39 (1.20–1.59). Conclusion Pooled results were significant in favor of radical cystectomy. The conclusion is mainly driven by large population-based studies that are at high RoB. Hence, the certainty of these treatment estimates can be considered very low and further research will likely have an important impact on these estimates. At present, the ultimate decision between trimodal therapy and radical cystectomy should be left to the patient based on individual preferences and on the recommendation of a multidisciplinary provider team experienced with both approaches.

Original languageEnglish (US)
Article numbere0216255
JournalPloS one
Volume14
Issue number4
DOIs
StatePublished - Apr 2019

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Cystectomy
systematic review
meta-analysis
Urinary Bladder Neoplasms
Muscle
Meta-Analysis
Muscles
muscles
therapeutics
Survival
Hazards
Therapeutics
observational studies
MEDLINE
Observational Studies
quantitative analysis
confidence interval
urinary bladder neoplasms
Confidence Intervals
Chemical analysis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer : Does the current quality of evidence justify definitive conclusions? / Wettstein, Marian S.; Rooprai, Jasjit K.; Pazhepurackel, Clinsy; Wallis, Christopher J.D.; Klaassen, Zachary; Uleryk, Elizabeth M.; Hermanns, Thomas; Fleshner, Neil E.; Zlotta, Alexandre R.; Kulkarni, Girish S.

In: PloS one, Vol. 14, No. 4, e0216255, 04.2019.

Research output: Contribution to journalReview article

Wettstein, Marian S. ; Rooprai, Jasjit K. ; Pazhepurackel, Clinsy ; Wallis, Christopher J.D. ; Klaassen, Zachary ; Uleryk, Elizabeth M. ; Hermanns, Thomas ; Fleshner, Neil E. ; Zlotta, Alexandre R. ; Kulkarni, Girish S. / Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer : Does the current quality of evidence justify definitive conclusions?. In: PloS one. 2019 ; Vol. 14, No. 4.
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title = "Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer: Does the current quality of evidence justify definitive conclusions?",
abstract = "Objectives To systematically review and meta-analyze the current literature in a methodologically rigorous and transparent manner for quantitative evidence on survival outcomes among patients diagnosed with muscle-invasive bladder cancer that were treated by either trimodal therapy or radical cystectomy. Materials and methods MEDLINE, EMBASE, CENTRAL were systematically searched for comparative observational studies reporting disease-specific survival and/or overall survival on adult patients diagnosed with localized muscle-invasive bladder cancer that were exposed to either trimodal therapy or radical cystectomy. Studies qualified for meta-analysis (random effects model) if they were not at critical risk of bias (RoB). Results The literature search identified 12 eligible studies. Three (all rated as “moderate RoB”) out of 6 studies reporting on disease-specific survival qualified for quantitative analysis and yielded a pooled hazard ratio (trimodal therapy versus radical cystectomy) of 1.39 (95{\%} confidence interval: 1.03–1.88). Four (mainly rated as “serious RoB”) out of 12 studies were included in the meta-analysis of overall survival and estimated a hazard ratio of 1.39 (1.20–1.59). Conclusion Pooled results were significant in favor of radical cystectomy. The conclusion is mainly driven by large population-based studies that are at high RoB. Hence, the certainty of these treatment estimates can be considered very low and further research will likely have an important impact on these estimates. At present, the ultimate decision between trimodal therapy and radical cystectomy should be left to the patient based on individual preferences and on the recommendation of a multidisciplinary provider team experienced with both approaches.",
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T1 - Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer

T2 - Does the current quality of evidence justify definitive conclusions?

AU - Wettstein, Marian S.

AU - Rooprai, Jasjit K.

AU - Pazhepurackel, Clinsy

AU - Wallis, Christopher J.D.

AU - Klaassen, Zachary

AU - Uleryk, Elizabeth M.

AU - Hermanns, Thomas

AU - Fleshner, Neil E.

AU - Zlotta, Alexandre R.

AU - Kulkarni, Girish S.

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N2 - Objectives To systematically review and meta-analyze the current literature in a methodologically rigorous and transparent manner for quantitative evidence on survival outcomes among patients diagnosed with muscle-invasive bladder cancer that were treated by either trimodal therapy or radical cystectomy. Materials and methods MEDLINE, EMBASE, CENTRAL were systematically searched for comparative observational studies reporting disease-specific survival and/or overall survival on adult patients diagnosed with localized muscle-invasive bladder cancer that were exposed to either trimodal therapy or radical cystectomy. Studies qualified for meta-analysis (random effects model) if they were not at critical risk of bias (RoB). Results The literature search identified 12 eligible studies. Three (all rated as “moderate RoB”) out of 6 studies reporting on disease-specific survival qualified for quantitative analysis and yielded a pooled hazard ratio (trimodal therapy versus radical cystectomy) of 1.39 (95% confidence interval: 1.03–1.88). Four (mainly rated as “serious RoB”) out of 12 studies were included in the meta-analysis of overall survival and estimated a hazard ratio of 1.39 (1.20–1.59). Conclusion Pooled results were significant in favor of radical cystectomy. The conclusion is mainly driven by large population-based studies that are at high RoB. Hence, the certainty of these treatment estimates can be considered very low and further research will likely have an important impact on these estimates. At present, the ultimate decision between trimodal therapy and radical cystectomy should be left to the patient based on individual preferences and on the recommendation of a multidisciplinary provider team experienced with both approaches.

AB - Objectives To systematically review and meta-analyze the current literature in a methodologically rigorous and transparent manner for quantitative evidence on survival outcomes among patients diagnosed with muscle-invasive bladder cancer that were treated by either trimodal therapy or radical cystectomy. Materials and methods MEDLINE, EMBASE, CENTRAL were systematically searched for comparative observational studies reporting disease-specific survival and/or overall survival on adult patients diagnosed with localized muscle-invasive bladder cancer that were exposed to either trimodal therapy or radical cystectomy. Studies qualified for meta-analysis (random effects model) if they were not at critical risk of bias (RoB). Results The literature search identified 12 eligible studies. Three (all rated as “moderate RoB”) out of 6 studies reporting on disease-specific survival qualified for quantitative analysis and yielded a pooled hazard ratio (trimodal therapy versus radical cystectomy) of 1.39 (95% confidence interval: 1.03–1.88). Four (mainly rated as “serious RoB”) out of 12 studies were included in the meta-analysis of overall survival and estimated a hazard ratio of 1.39 (1.20–1.59). Conclusion Pooled results were significant in favor of radical cystectomy. The conclusion is mainly driven by large population-based studies that are at high RoB. Hence, the certainty of these treatment estimates can be considered very low and further research will likely have an important impact on these estimates. At present, the ultimate decision between trimodal therapy and radical cystectomy should be left to the patient based on individual preferences and on the recommendation of a multidisciplinary provider team experienced with both approaches.

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