title: Optimal schedule of bacillus calmette-guerin for non-muscle-invasive bladder cancer: a meta-analysis of comparative studies.
abstract: BACKGROUND
  To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).
  
  
  METHODS
  Comprehensive searches of electronic databases (PubMed, Embase, and the Cochrane Library) were performed, then a systematic review and cumulative meta-analysis of 21 randomized controlled trials (RCTs) and 9 retrospective comparative studies were carried out according to predefined inclusion criteria.
  
  
  RESULTS
  Significantly better recurrence-free survivals (RFS) were observed respectively in patients who received BCG maintenance, standard-dose and BCG plus epirubicin therapy comparing to those received induction, low-dose and BCG alone. BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events. Pooled results showed no remarkable advantage of BCG combined with Mitomycin C or with interferon α-2b in improving oncologic outcomes. Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity. Our data confirmed that non-RCT only affected strength rather than direction of the overall results.
  
  
  CONCLUSIONS
  All patients with superficial BCa should be encouraged to accept BCG maintenance therapy with standard-dose if well tolerated. Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.
authors.affiliation: Department of Urology, Tianjin Institute of Urology, 2nd Hospital of Tianjin Medical University, Pingjiang Road 23, Tianjin, People's Republic of China.
authors.forename: Shimiao
authors.initials: S
authors.lastname: Zhu
authors.forename: Yang
authors.initials: Y
authors.lastname: Tang
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.forename: Zhiqun
authors.initials: Z
authors.lastname: Shang
authors.forename: Ning
authors.initials: N
authors.lastname: Jiang
authors.forename: Xuewu
authors.initials: X
authors.lastname: Nian
authors.forename: Libin
authors.initials: L
authors.lastname: Sun
authors.forename: Yuanjie
authors.initials: Y
authors.lastname: Niu
mesh_terms: D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D001500:BCG Vaccine