Laser versus transurethral resection of bladder tumor for non-muscle invasive bladder cancer: a systematic review and meta-analysis

doi:10.3877/cma.j.issn.1674-3253.2017.02.004

Abstract

Abstract:

Objective

To provide a systematic review and meta-analysis of studies comparing laser versus transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC).

Methods

This study comprehensively searched PubMed, Scopus, Web of science, Cochrane library, and performed a systematic review and meta-analysis of all randomized controlled trials (RCTs), retrospective comparative studies and prospective studies assessing the two techniques.

Results

Nine studies including 4 RCTs, 4 retrospective studies and 1 prospective study fulfilled the predefined inclusion criteria and were included in the final analysis. These studies included data of 1396 cases (694 for lasers and 702 for TURBT). Although there was no significant difference between lasers and TURBT for operation time (WMD=1.63, 95%CI=-1.44~4.70, P=0.30), lasers provided shorter hospital stays (WMD=-1.11, 95%CI=-1.71~- 0.50, P=0.0004) as well as lower complication rates. What's more, the recurrence rates showed no significantly difference when we took a one-year follow-up (OR=0.87, 95% CI=0.59~1.27, P=0.47), or even two-year follow-up (OR=0.70, 95% CI=0.46~1.09, P=0.11).

Conclusions

Laser is not only safer, but also has the same efficacy as TURBT when dealing with NMIBC. And it should be recommended when minimally invasive therapy is necessary.

Key words: Laser, Bladder tumor, Bladder resection, Meta-analysis

Haofeng Zheng, Guancan Liang, Yanxiong Chen, Tengcheng Li, Jieying Wu, Jie Situ, Xin Gao. Laser versus transurethral resection of bladder tumor for non-muscle invasive bladder cancer: a systematic review and meta-analysis[J]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(02): 86-91.

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References 19

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研究文献	选择代表性			对比代表性		结局代表性		质量分数
研究文献	随机分配	典型激光组	典型电切组	比较1,2,3,4^*	比较5,6,7,8^*	结果评估	充分随访	质量分数
Migliari等^[11]	否	是	是	1,4	6,7,8	是	是	6
Muraro等^[12]	否	是	是	1,2	7,8	是	是	6
Tao等^[13]	否	是	是	1,2,4	5,6,7,8	是	是	7
Yang等^[14]	否	是	是	1,2,4	5,6,7,8	是	是	7
Zhu等^[15]	否	是	是	1,2,4	5,6,7,8	是	是	7

研究文献	选择代表性			对比代表性		结局代表性		质量分数
研究文献	随机分配	典型激光组	典型电切组	比较1,2,3,4^*	比较5,6,7,8^*	结果评估	充分随访	质量分数
Migliari等^[11]	否	是	是	1,4	6,7,8	是	是	6
Muraro等^[12]	否	是	是	1,2	7,8	是	是	6
Tao等^[13]	否	是	是	1,2,4	5,6,7,8	是	是	7
Yang等^[14]	否	是	是	1,2,4	5,6,7,8	是	是	7
Zhu等^[15]	否	是	是	1,2,4	5,6,7,8	是	是	7

研究	选择偏倚		实施偏倚	随访偏倚	测量偏倚	报告偏倚	其他偏倚
研究	随机分配	分配隐藏	盲法	数据齐全	结局隐藏	选择性报告	其他偏倚
Chen等^[16]	低风险	低风险	低风险	低风险	低风险	低风险	未知风险
Liu等^[17]	低风险	低风险	低风险	低风险	低风险	低风险	未知风险
Xu等^[18]	低风险	低风险	低风险	低风险	低风险	低风险	未知风险
Zhang等^[19]	未知风险	低风险	低风险	低风险	低风险	低风险	未知风险

研究	选择偏倚		实施偏倚	随访偏倚	测量偏倚	报告偏倚	其他偏倚
研究	随机分配	分配隐藏	盲法	数据齐全	结局隐藏	选择性报告	其他偏倚
Chen等^[16]	低风险	低风险	低风险	低风险	低风险	低风险	未知风险
Liu等^[17]	低风险	低风险	低风险	低风险	低风险	低风险	未知风险
Xu等^[18]	低风险	低风险	低风险	低风险	低风险	低风险	未知风险
Zhang等^[19]	未知风险	低风险	低风险	低风险	低风险	低风险	未知风险

研究文献	设计类型	证据等级	激光类型	患者例数		肿瘤分级			肿瘤分期
研究文献	设计类型	证据等级	激光类型	Laser	TURBT	低级	PUNLMP	高级	Tis	Ta	T1
Chen^[16]	RCT	2b	2-micron	71	71	43:45	5:9	23:17	23:17	43:55	25:15
Liu^[17]	RCT	2b	Thulium	64	64	46:41	11:10	7:5	0	37:34	27:22
Migliari^[11]	R	3b	Thulium	58	61	NR	NR	NR	NR	NR	NR
Muraro^[12]	R	3b	Holmium	50	50	NR	NR	NR	0:0	43:46	7:4
Tao^[13]	R	3b	KTP	74	84	60:68	9:10	5:6	1:2	50:61	23:21
Xu^[18]	RCT	2b	KTP	99	94	39:41	50:48	10:5	0:0	91:82	8:12
Yang^[14]	R	3b	KTP	28	32	NR	NR	NR	0:0	8:7	20:25
Zhang^[19]	RCT	2b	Thulium	149	143	54:60	87:75	8:8	0:0	106:107	43:36
Zhu^[15]	RP	3b	Holmium	101	111	NR	NR	NR	5:7	67:70	34:41

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