In the absence of large trials, it is important for us to discuss whether a well-conducted meta-analysis of smaller randomized controlled trial (RCT) can replace large trials or not. We have evaluated the quality of original literature and methodological quality. The difference between meta-analysis of smaller RCT and the largest randomized trials have also discussed.
Objective To assess the efficacy and the treatment-induced side effects of intravesically administered Epirubicin (EPI) following TUR in patients with Ta and T1 superficial bladder cancer compared to TUR alone. Methods According to the Cochrane reviewer’s handbook, included studies were those on patients with histologically confirmed Ta and T1 bladder cancer. EPI and EPI derivatives, dose and schedule would be considerd appropriate for inclusion. The search strategy was developed according to the Collaborative Review Group search strategy. Medline, EMbase, CBMdisc and the Cochrane library, articles of conference proceedings, and academic collections were searched for randomised controlled trials (RCTs) and quasi-RCT comparing intravesical EPI following TUR with TUR alone. Data were extracted from each identified paper independently by two reviewers. Trials were assessed for quality according to the method of Jadad scale. RevMan4.2 software developed by the Cochrane Collaboration was used for satistical analysis. Results Two hundred and thirteen related articles were identified, but only 10 were included in our systematic review. 3 articles were high quality and the rest were low. The pooled RR=1.51 (95%CI 1.32 to 1.72) and the pooled RR=1.49 (95%CI 1.35 to 1.66) in patients with Ta and T1 bladdercancer at 1 and 2 years respectively; The pooled RR=1.34 (95%CI 1.22 to 1.48) when comparing relative efficacy of intravesical EPI (drug doselt;50 mg) following TUR with TUR alone; The pooled RR=1.63 (95%CI 1.48 to 1.79) when comparing relative efficacy of intravesical EPI (drug dosegt;50 mg) following TUR with TUR alone. RR=1.49 (95%CI 1.33 to 1.66) and RR=1.56 (95%CI 1.36 to 1.84) when comparing relative efficacy of single intravesical EPI following TUR with TUR alone respectively. RR=0.79 (95%CI 0.53 to 1.17) when comparing the incidence of disease progression of intravesical doxorubicin following TUR with TUR alone. RR=4.34 (95%CI 2.62 to 7.19) when comparing side effect of intravesical EPI following TUR with TUR alone. Conclusions Intravesically administered EPI following TUR in patients with Ta and T1 superficial bladder cancer may reduce the incidence of tumour recurrence, but cannot reduce the incidence of disease progreesion. Intravesically administered EPI following TUR has some side effects but can be tolerated and has no influence on the life of patients.
Objective To analysis the original articles published in Chinese Journal of Urology and to evaluate the present situation of the clinical and scientific research in the field of urology, providing clue to raise the clinical and scientific research level. Methods Chinese Journal of Urology and Journal of Urology in American were hand-searched and all original articles were divided into eight types and were identified and analyzed. The classes include descriptive studies, therapeutic studies, studies on diagnosis, etiology, prognosis etc. Results The decreased trend year by year were observed for the descriptive studies (χ2=286.179, Plt;0.005), number of such publications accounting for 71.90% in 1980-1984 down to 26.48% in 1999-2001. Number of randomized controlled trials and clinical controlled trials present distinct increasing trend, especially number of RCT increased from none in 1980-1984 to thirteen articles in 1995-1998. The proportion of laboratory research in all original articles have increased greatly and have exceeded that of Journal of Urology. Conclusions The clinical and scientific research level of urology have been elevating in our country, the constituent ratio of descriptive studies is decreasing and that of RCT and CCT is increasing. The constituent ratio of laboratory research has increased greatly and has exceeded that of similar foreign Journal in some years. Attention needs to be paid to this trend and mechanism of it should be further explored.
Objective To determine whether intravesically administered Adriamycin can prevent superficial bladder tumor to recur through assessing the efficacy of with intravesical Adriamycin and without intravesical Adriamycin after TURB-t. Method The search strategy was made according to the demand of Cochrane Collaboration. Medline, Embase，CBMdisc and the Cochrane Library were searched for RCTs. Data were extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Thirty three relevant trials were searched, of which eighteen trials were included and fifteen trials were excluded. Meta-analysis showed intravesically administered Pirarnbicin (THP), Epirubicin (EPI) and Adriamycin (ADM) can reduce the recurrence rate of superficial bladder cancer after operation during one or two years. Conclusions Intravesically administered THP, EPI and ADM can reduce the recurrence rate of superficial bladder cancer after TUPB-t’s operation during one or two years. In addition, the factors affecting the prognosis should be performed, such as the dosage of irrigation of bladder, reserving time and the course.