Comparison of the combination therapy of bacillus Calmette-Guérin and mitomycin C with the monotherapy for non-muscle-invasive bladder cancer: A meta-analysis

Abstract

Urinary bladder cancer is one of the most frequent cancers worldwide. Non-muscle-invasive bladder carcinoma (NMIBC) has a very low curative rate after resection. The meta-analysis aims to compare efficiency of the combination therapy of bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) with each monotherapy on NMIBC treatment. Articles were retrieved in relevant databases up to May, 2016. The Cochrane Collaboration Risk of Bias Tool was used to assess quality of the included studies. Risk ratio (RR) and the 95% confidence interval (CI) were used as the effect size to calculate pooled result. Funnel plot and Egger’s test were applied to examine publication bias. Sensitive analysis was performed. Eight randomized controlled trials were included in this meta-analysis. As a result, the BCG+MMC combination therapy had a significantly decreased recurrence rate in NMIBC patients, compared with monotherapy of BCG or MMC (RR = 0.81, 95% CI: 0.72 to 0.92, P < 0.001). However, there were no obvious differences between the two regimens regarding to progression rate, overall mortality and disease-specific mortality (P > 0.050). Subgroup analysis indicated the combination therapy was more advantageous than BCG (RR = 0.73, 95% CI: 0.61 to 0.87) but not MMC monotherapy (P > 0.050), on the reduced recurrence rate. 81mg/week BCG + 30 mg/week MMC had a significant lower progression rate than BCG (RR = 0.44, 95%CI: 0.24 to 0.82). In conclusion, BCG+MMC combination therapy is more advantageous than BCG to NMIBC patients with reduced recurrence rate.