Frontiers in oncology · 2026
Choosing neoadjuvant therapy for muscle-invasive bladder cancer based on efficacy-safety trade-off: a network meta-analysis.
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Zhao Zilin, Liu Xinyu, Zhong Qikai, Liu Lin, Pan Runze, Chen Junzhi, Wang Xinlei, Liu Xing, Bao Jiangshang, Sun Yufeng, Han Conghui, Shi Zhenduo, Liang Qing
Аннотация
INTRODUCTION: Muscle-invasive bladder cancer (MIBC) carries a poor prognosis, and the optimal neoadjuvant treatment strategy remains debated. This study aimed to systematically compare the efficacy and safety of neoadjuvant chemoimmunotherapy (NICT), chemotherapy alone (NAC), and immunotherapy alone (IT) for MIBC.
METHODS: A Bayesian network meta-analysis was conducted. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for relevant randomized controlled trials and prospective/retrospective cohort studies published up to June 2025. The primary outcomes were pathological complete response (pCR) rate and the incidence of grade ≥3 treatment-related adverse events (TRAEs). Data analysis was performed using R software with appropriate packages for network meta-analysis.
RESULTS: Fourteen studies involving 2234 patients were included. The pooled pCR rate was highest for NICT (0.41, 95% CI: 0.37-0.46), followed by IT (0.26, 95% CI: 0.17-0.39) and NAC (0.15, 95% CI: 0.10-0.23). Network meta-analysis showed NICT was significantly superior to NAC for pCR (OR = 4.2, 95% CI: 2.0-8.2). For grade ≥3 TRAEs, the pooled incidence was highest for NAC (0.19, 95% CI: 0.07-0.39), followed by NICT (0.12, 95% CI: 0.09-0.18) and IT (0.06, 95% CI: 0.04-0.10), with no statistically significant pairwise differences. Ranking probabilities indicated NICT had the highest likelihood of being the most efficacious treatment but also the highest probability of adverse events.
CONCLUSION: NICT demonstrates the best efficacy in the neoadjuvant treatment of MIBC but is associated with relatively higher toxicity, making it suitable for patients with good cisplatin tolerance. However, the analysis is limited by the lack of long-term survival outcomes such as overall survival and recurrence-free survival. IT offers a safer profile with meaningful efficacy and represents a viable option for patients with poor toxicity tolerance. Treatment selection should be individualized based on efficacy-safety trade-offs and patient-specific factors.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251171346, identifier CRD420251171346.
METHODS: A Bayesian network meta-analysis was conducted. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for relevant randomized controlled trials and prospective/retrospective cohort studies published up to June 2025. The primary outcomes were pathological complete response (pCR) rate and the incidence of grade ≥3 treatment-related adverse events (TRAEs). Data analysis was performed using R software with appropriate packages for network meta-analysis.
RESULTS: Fourteen studies involving 2234 patients were included. The pooled pCR rate was highest for NICT (0.41, 95% CI: 0.37-0.46), followed by IT (0.26, 95% CI: 0.17-0.39) and NAC (0.15, 95% CI: 0.10-0.23). Network meta-analysis showed NICT was significantly superior to NAC for pCR (OR = 4.2, 95% CI: 2.0-8.2). For grade ≥3 TRAEs, the pooled incidence was highest for NAC (0.19, 95% CI: 0.07-0.39), followed by NICT (0.12, 95% CI: 0.09-0.18) and IT (0.06, 95% CI: 0.04-0.10), with no statistically significant pairwise differences. Ranking probabilities indicated NICT had the highest likelihood of being the most efficacious treatment but also the highest probability of adverse events.
CONCLUSION: NICT demonstrates the best efficacy in the neoadjuvant treatment of MIBC but is associated with relatively higher toxicity, making it suitable for patients with good cisplatin tolerance. However, the analysis is limited by the lack of long-term survival outcomes such as overall survival and recurrence-free survival. IT offers a safer profile with meaningful efficacy and represents a viable option for patients with poor toxicity tolerance. Treatment selection should be individualized based on efficacy-safety trade-offs and patient-specific factors.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251171346, identifier CRD420251171346.