title: [Effects of neoadjuvant chemotherapy on the prognostic mortality risk of invasive transitional bladder cancer: a meta-analysis].
abstract: OBJECTIVE
  To systematically assess the effects of neoadjuvant chemotherapy on the prognostic risk of invasive transitional bladder cancer.
  
  
  METHODS
  All known randomized controlled trials (RCTs) on neoadjuvant chemotherapy in the treatment of invasive transitional bladder cancer, published from the date of database building to September 2012, were retrieved from such databanks as Pubmed, CBMdisc, Embase and Cochrane. The data on 5-year survival rate of included studies were extracted for further heterogeneity exploration, subgroup analysis and statistical pooling with the RevMan 5.10 software.
  
  
  RESULTS
  Fourteen subjects involving 2072 cases and 2086 controls were published from 1991 to 2012. The overall odds ratio of survival suggested a 21% relative reduction in mortality risk for neoadjuvant chemotherapy compared to that on control (OR = 0.79, 95%CI:0.70-0.90). In subgroup analysis according to different neoadjuvant chemotherapies, MCV (methotrexate, cisplatin and vinblastine) and MVAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapies showed significant benefit to overall survival with 28% and 25% reduction in risk of death respectively (OR = 0.72,95%CI:0.60-0.86, OR = 0.75,95%CI:0.59-0.96) . However, no significant difference existed in effects between C (cisplatin) chemotherapy, CM (cisplatin and methotrexate) chemotherapy and CD (cisplatin and docetaxel) chemotherapy and controls. In subgroup analysis according to local treatment of cystectomy or radiotherapy after neoadjuvant chemotherapy, the patients with cystectomy showed significant benefits in overall survival with 25% reduction in risk of death (OR = 0.75, 95%CI:0.65-0.87). However, the patients with radiotherapy or radiotherapy plus cystectomy showed no significant benefits in overall survival.
  
  
  CONCLUSIONS
  MCV and MVAC neoadjuvant chemotherapies improve survival among patients with bladder cancer. And neoadjuvant chemotherapy has better long-term survival after cystectomy.
authors.affiliation: First Department of Urology, First Affiliated Hospital, Dalian Medical University, Dalian 116011,China.
authors.forename: Bo
authors.initials: B
authors.lastname: Fan
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
authors.forename: Xian-cheng
authors.initials: XC
authors.lastname: Li
authors.forename: Yong-sheng
authors.initials: YS
authors.lastname: Song
authors.forename: En-zhong
authors.initials: EZ
authors.lastname: Guo
authors.forename: Tao
authors.initials: T
authors.lastname: Pan
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.forename: Shi-yong
authors.initials: SY
authors.lastname: Xin
authors.forename: Xi-shuang
authors.initials: XS
authors.lastname: Song
authors.forename: Jian-bo
authors.initials: JB
authors.lastname: Wang
mesh_terms: D006801:Humans; D020360:Neoadjuvant Therapy / Q000401:mortality*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*