[Application of principles of evidence-based medicine in cancer of the urinary bladder].
Meta-analysis has been made to answer the question whether a proven advantage exists of chemotherapy of locally advanced and metastatic cancer of the urinary bladder (UB) with gemcitabine+cisplatin over the scheme M-VAC. The data for 1990-2002 obtained from the data base Medline, library of Cocrane Association, proceedings of the symposia and conferences, publications in domestic periodicals Urologiya, Voprosy Onkologii covered 3477 items on UB cancer. Nine publications were selected which seem to use significant information in terms of evidence-based medicine. The patients were divided into two groups. Group 1 consisted of patients with local and metastatic UB cancer treated with the combination gemcitabine+cisplatin (n = 390). Group 2 patients (n = 499) received chemotherapy with M-VAC. By principles of evidence-based medicine, group 1 patients had more frequent unfavourable outcomes (absence of complete and partial regressions)--50 and 42%, respectively. A decrease in the absolute risk is significant (p < 0.05, chi-square = 5.8). It is 8% in the confidence interval (CI) 4,12. A decrease in the relative risk was 19% (CI 13.7-24.3), odds ratio 1.39 in CI 1.3-1.48. Thus, at present there are no reliable data on advantages of local and metastatic UB cancer treatment with the scheme gemcitabine-cysplatin over standard treatment M-VAC.
O I
OI
Apolikhina
I V
IV
Chernyshev
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D019317:Evidence-Based Medicine; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine