ObjectiveTo perform a systematic review and meta‐analysis of trials comparing trimodal therapy (TMT) and radical cystectomy (RC), evaluating differences in terms of oncological outcomes, quality of life, and costs.Materials and MethodsIn July 2023, a literature search of multiple databases was conducted to identify studies analysing patients with cT2‐4 N any M0 muscle‐invasive bladder cancer (MIBC; Patients) receiving TMT (Intervention) compared to RC (Comparison), to evaluate survival outcomes, recurrence rates, costs, and quality of life (Outcomes). The primary outcome was overall survival (OS). Secondary outcomes were cancer‐specific survival (CSS) and metastasis‐free survival (MFS). Hazard ratios (HRs) were used to analyse survival outcomes according to different treatment modalities and odds ratios were used to evaluate the likelihood of receiving each type of treatment according to T stage.ResultsNo significant difference in terms of OS was observed between RC and TMT (HR 1.07, 95% confidence interval [CI] 0.81–1.4; P = 0.6), even when analysing radiation therapy regimens ≥60 Gy (HR 1.02, 95% CI 0.69–1.52; P = 0.9). No significant difference was observed in CSS (HR 1.12, 95% CI 0.79–1.57, P = 0.5) or MFS (HR 0.88, 95% CI 0.66–1.16; P = 0.3). The mean cost of TMT was significantly higher than that of RC ($289 142 vs $148 757; P < 0.001), with greater effectiveness in terms of cost per quality‐adjusted life‐year. TMT ensured significantly higher general quality‐of‐life scores.ConclusionTrimodal therapy appeared to yield comparable oncological outcomes to RC concerning OS, CSS and MFS, while providing superior patient quality of life and cost effectiveness.

中文翻译：

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肌层浸润性膀胱癌患者的三模式治疗与根治性膀胱切除术：比较研究的系统评价和荟萃分析

目的对比较三模式治疗 (TMT) 和根治性膀胱切除术 (RC) 的试验进行系统回顾和荟萃分析，评估肿瘤结果、生活质量和费用方面的差异。材料和方法2023 年 7 月，对多个进行数据库的目的是分析接受 TMT（干预）与 RC（比较）的 cT2-4 N 任何 M0 肌层浸润性膀胱癌（MIBC；患者）患者的研究，以评估生存结果、复发率、成本和质量生活（结果）。主要结局是总生存期（OS）。次要结局是癌症特异性生存期（CSS）和无转移生存期（MFS）。根据不同的治疗方式，使用风险比（HR）分析生存结果，并使用比值比根据 T 分期评估接受每种治疗的可能性。结果 RC 和 TMT 之间在 OS 方面没有观察到显着差异（ HR 1.07，95% 置信区间 [CI] 0.81–1.4；磷= 0.6），即使在分析≥60 Gy 的放射治疗方案时也是如此（HR 1.02，95% CI 0.69–1.52；磷= 0.9）。 CSS 没有观察到显着差异（HR 1.12，95% CI 0.79–1.57，磷= 0.5）或 MFS（HR 0.88，95% CI 0.66–1.16；磷= 0.3）。 TMT 的平均成本显着高于 RC（289 142 美元 vs 148 757 美元；磷< 0.001），在每个质量调整生命年的成本方面具有更高的有效性。 TMT 确保了显着更高的总体生活质量评分。 结论 三模式治疗似乎在 OS、CSS 和 MFS 方面产生了与 RC 相当的肿瘤学结果，同时提供了卓越的患者生活质量和成本效益。