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Device-assisted intravesical chemotherapy versus bacillus Calmette–Guerin for intermediate or high-risk non-muscle invasive bladder cancer: a systematic reviewer and meta-analysis

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the effectiveness and safety of device-assisted intravesical chemotherapy compared to Bacillus Calmette–Guerin (BCG) in the treatment of patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC).

Methods

In February 2023, a systematic search was conducted on the PubMed, Cochrane, and Embase databases. Following the PRISMA guidelines, a systematic review and meta-analysis of the primary outcomes of interest were performed. The review was prospectively registered on PROSPERO under the registration number CRD42023398559.

Results

A total of 10 studies involving 1160 patients were included. The results of the meta-analysis showed that compared to BCG, device-assisted chemotherapy had a lower recurrence rate (OR: 0.63, 95% CI: 0.48–0.84, p = 0.001), longer recurrence-free survival (OR: 0.64, 95% CI: 0.47–0.88, p = 0.006), and lower incidence of fever (OR: 0.18, 95% CI: 0.08–0.44, p = 0.0002). However, no significant differences were observed between the two groups in terms of progression, overall survival, progression-free survival, disease-free survival, overall adverse events, serious adverse events, hematuria, allergy, and general discomfort. Subgroup analysis revealed that neither chemohyperthermia (CHT) nor electromotive drug administration (EMDA) showed statistically significant differences in oncological outcomes compared to BCG. Regarding adverse events, both CHT and EMDA groups showed lower rates of fever compared to the BCG group (OR: 0.26, 95% CI: 0.10–0.67, p = 0.005, and OR: 0.14, 95% CI: 0.05–0.37, p < 0.0001, respectively). No significant differences were observed in the remaining adverse events between either the CHT or EMDA group and the BCG group.

Conclusion

Device-assisted intravesical chemotherapy appears to be a safe and viable alternative to BCG for patients with intermediate and high-risk NMIBC, showing comparable oncological outcomes and adverse events.

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Data availability

All data generated and analyzed during this study are included in this published article.

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Funding

This study was funded by the National Natural Science Foundation of China (Grant Number: 82160148), and the “Cuiying Science and Technology Innovation” Program of the Second Hospital of Lanzhou University (Grant Number: CY2022-QN-B04).

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Authors and Affiliations

  1. Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China

    Chengyu You, Qingchao Li, Liangliang Qing, Rongxin Li, Yanan Wang, Long Cheng & Zhilong Dong

  2. Institute of Urology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China

    Chengyu You, Qingchao Li, Liangliang Qing, Rongxin Li, Yanan Wang, Long Cheng & Zhilong Dong

  3. Gansu Province Key Laboratory of Urological Diseases, Lanzhou, 730030, Gansu, China

    Chengyu You, Qingchao Li, Liangliang Qing, Rongxin Li, Yanan Wang, Long Cheng & Zhilong Dong

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  4. Rongxin Li
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  5. Yanan Wang
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  6. Long Cheng
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  7. Zhilong Dong
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Contributions

Conceived and designed the experiments: Zhilong Dong. Analyzed the data: Chengyu You, Qingchao Li and Liangliang Qing. Contributed reagents/materials/analysis: Rongxin Li, Yanan Wang, and Long Cheng. Wrote the manuscript: Chengyu You and Qingchao Li. All authors have read and approved the final manuscript.

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Correspondence to Zhilong Dong.

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You, C., Li, Q., Qing, L. et al. Device-assisted intravesical chemotherapy versus bacillus Calmette–Guerin for intermediate or high-risk non-muscle invasive bladder cancer: a systematic reviewer and meta-analysis. Int Urol Nephrol 56, 103–120 (2024). https://doi.org/10.1007/s11255-023-03765-0

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