title: Treatment of muscle-invasive bladder cancer: A systematic review.
abstract: There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Selph
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
authors.forename: David I
authors.initials: DI
authors.lastname: Buckley
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Gustafson
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Griffin
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Grusing
authors.affiliation: Department of Urology, Pacific Northwest Evidence-based Practice Center, University of Washington CHASE Alliance, Seattle, Washington.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
chemical_list: D002945:Cisplatin
keywords: adjuvant chemotherapy; bladder cancer; bladder-sparing therapy; lymph node dissection; neoadjuvant chemotherapy; radical cystectomy