Meta analysis of 2-μm laser in the treatment of non-muscle-invasive bladder tumor

doi:10.3969/j.issn.2095-4344.2013.53.025

Abstract

Abstract:

BACKGROUND: 2-μm laser is a novel intracavity technique for treating non-muscle-invasive bladder tumor, but the efficacy and safety in comparison with transurethral resection of bladder tumor are poorly understood.

OBJECTIVE: To evaluate the difference of curative effect between 2-μm laser and transurethral resection of bladder tumor in treatment of non-muscle-invasive bladder tumor, and to provide medicine-based evidence for clinical application.

METHODS: An online retrieval of PubMed, Ovid, Medline, Embase, Cochrane Library, CBM, CNKI, Wanfang database, Weipu database and Superstar database was performed. We also supplemented by manual and other retrieval. The retrieval time arranged from inception until September 30, 2013. Randomized controlled trials of 2-μm laser and transurethral resection of bladder tumor in treatment of non-muscle invasive bladder tumor were searched. Meta analysis was performed using RevMan5.2 software after the data were abstracted and the quality was evaluated.

RESULTS AND CONCLUSION: Four randomized controlled trials involving 310 patients were included, 161 cases in 2-μm laser group and 149 cases in transurethral resection of bladder tumor group. The results of Meta analysis showed that compared with transurethral resection of bladder tumor group, postoperative bladder irrigation time (SMD=-3.61, 95%CI [-4.41, -3.13]) and period of catheterization (MD=-1.47, 95%CI [-2.32, -0.62]) were shorter in 2-μm laser group, with less incidence of obturator nerve reflex (RR=0.07, 95%CI[0.01, 0.34]), bladder irritation (RR=0.30, 95%CI [0.19, 0.47]) and bladder perforation (RR=0.09, 95%CI [0.02, 0.45] ). There were no significant differences in operation time, period of hospitalization, postoperative urethral stricture incidence and bladder tumor recurrence rate in short-term between the two groups. Experimental findings indicate that, 2-μm laser is similar to transurethral resection of bladder tumor in treatment of non-muscle invasive bladder tumor. But the incidence of obturator nerve reflex, bladder irrigation and bladder perforation is lower, postoperative bladder irrigation time and period of catheterization were shorter than transurethral resection of bladder tumor. So 2-μm laser is a minimally invasive technique with definite effect and relatively high safety. Due to the quality of the included studies and possible publication bias, the above conclusions still need more high-quality randomized controlled trials to validate.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

CLC Number:

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Yu Jie, Wang Yu-jie, Liu Yu, Ma Qi, Zhang Li-dong. Meta analysis of 2-μm laser in the treatment of non-muscle-invasive bladder tumor[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(53): 9251-9260.

Figures/Tables 8

2.3.2 治疗后住院时间纳入4个研究中只有3个研究比较了2种方案治疗后的住院时间[5-6，8]，其中Liu等[5]研究认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后住院时间差异有显著性意义，而余下2个研究则认为差异无显著性意义[7-8]。Meta分析前对纳入研究结果进行异质性检验，各项研究结果间有明显有统计学异质性，I2=95%，分析异质性产生原因可能为不同研究间差异存在显著性，考虑剔除纳入研究中SD差异显著者，再次对纳入研究结果进行异质性检验(χ2=0.03，P=0.87>0.1，I2=0%)，研究结果间无明显统计学异质性，故采用固定效应模型进行Meta分析，结果：加权均数差的合并效应量MD=-0.42，MD合并95%CI[-0.86，0.03]，置信区间包含0，合并效应量检验，Z=1.82，P=0.07。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后住院时间差异无显著性意义，见图3。 2.3.3 治疗后留置尿管时间纳入研究中只有2个研究比较了治疗后留置尿管时间[5，8]。2个研究间有明显统计学异质性(χ²=5.96，P=0.01 < 0.1，I2=83%)，故采用随机效应模型进行Meta分析，结果：加权均数差的合并效应量MD=-1.47，MD合并95%CI[-2.32，-0.62]，置信区间不包含0，合并效应量检验，Z=3.39，P=0.000 7。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后留置尿管时间差异有显著性意义，经尿道2 μm激光膀胱肿瘤切除后留置尿管时间相对较短，见图4。 2.3.4 治疗后膀胱冲洗时间纳入研究中只有Liu等[5]、Wang等[8]研究比较2种方案治疗后膀胱冲洗时间，均认为2 μm激光组治疗后膀胱冲洗时间短于经尿道膀胱肿瘤切除组。考虑到各研究SD差异较大改用相对效应指标SMD行Meta分析，Meta分析前对纳入研究结果进行异质性检验，各项研究结果间无明显统计学异质性(χ2= 0.00，P=0.95>0.1，I2=0)，故采用固定效应模型进行Meta分析，结果：合并效应量SMD=-3.61，SMD合并95%CI[-4.09，-3.13]，置信区间不包含0，合并效应量检验，Z=14.80，P < 0.000 01。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后膀胱冲洗时间差异有显著性意义，经尿道2 μm激光膀胱肿瘤切除后膀胱冲洗时间相对较短，见图5。"

2.3.5 治疗过程中、治疗后并发症膀胱刺激：纳入研究中有2个研究比较膀胱刺激发生率[5，8]。Meta分析前对纳入研究结果进行异质性检验，各项研究结果间无明显统计学异质性(χ²=0.14，P=0.71>0.1，I2=0%)，故采用固定效应模型进行Meta分析，结果：合并效应量RR=0.30，RR合并95%CI[0.19，0.47]，置信区间不包含1，合并效应量检验，Z=5.23，P < 0.000 01。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤膀胱刺激发生率差异有显著性意义，前者膀胱刺激发生的风险仅为后者的30%，见图6。闭孔神经反射：纳入4个研究全部比较术中闭孔神经反射发生率。4个研究间无明显统计学异质性(χ2= 0.33，P=0.85 > 0.1，I2=0%)，故采用固定效应模型进行Meta分析，结果：合并效应量RR=0.07，RR合并95%CI[0.01，0.34]，置信区间不包含1，合并效应量检验，Z=3.24，P=0.001。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤术中闭孔神经反射发生率差异有显著性意义，2 μm激光组较经尿道膀胱肿瘤切除组闭孔神经反射发生率低；与经尿道膀胱肿瘤切除组比较，2 μm激光组将闭孔神经反射发生风险降低至7%，见图6。膀胱穿孔：纳入4个研究中均比较治疗后膀胱穿孔发生率。Meta分析前对纳入研究结果进行异质性检验，各项研究结果间无明显统计学异质性(χ2=0.03，P=0.99>0.1，I2=0%)，故采用固定效应模型进行Meta分析，结果：合并效应量RR=0.09，RR合并95%CI[0.02，0.45]，置信区间不包含1，合并效应量检验，Z=2.92，P=0.004。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后膀胱穿孔发生率差异有显著性意义；与经尿道膀胱肿瘤切除组比较，2 μm激光组降低了91%膀胱穿孔发生风险，见图6。尿道狭窄：纳入研究中只有3个研究比较了治疗后尿道狭窄发生率[5，7-8]。Meta分析前对纳入研究结果进行异质性检验，各项研究结果间无明显统计学异质性(χ2= 1.53，P=0.47>0.1，I2=0%)，故采用固定效应模型进行Meta分析，结果：合并效应量RR=0.73，RR合并95%CI[0.20，2.67]，置信区间包含1，合并效应量检验，Z=0.48，P=0.63。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤尿道狭窄发生率差异无显著性意义，见图6。 2.3.6 治疗后短期膀胱肿瘤复发率纳入4个研究均比较了2种治疗方案治疗后短期(3-12个月)随访期间膀胱肿瘤复发率，4个研究认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后短期膀胱肿瘤复发率差异无显著性意义。Meta分析前对纳入研究结果进行异质性检验，各项研究结果无明显统计学异质性(χ2=0.19，P=0.98>0.1，I2=0%)，故采用固定效应模型进行Meta分析，结果：合并效应量RR=0.88，RR合并95%CI[0.47，1.64]，置信区间包含1，合并效应量检验，Z=0.41，P=0.68。故认为经尿道2 μm激光膀胱肿瘤切除与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤后短期膀胱肿瘤复发率差异无显著性意义，见图7。"

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