To determine the effectiveness of adjuvant chemotherapy compared with neoadjuvant chemotherapy in patients with node-positive penile cancer in terms of overall and disease-free survival.
We conducted a search strategy in MEDLINE, Embase, and Central databases. We complemented the search with unpublished literature through manual search, conferences, thesis databases, Open Grey, Google Scholar, and Clinicaltrials.gov. There were no restrictions in language. We used the MINORS tool to assess the risk of bias. Furthermore, we performed a random-effects meta-analysis according to the expected heterogeneity. The outcomes were overall survival, progression-free survival, and adverse effects. The Effect measure was hazard ratio (HR) with a confidence interval of 95%.
We included 1,197 patients. Seven articles reported overall survival; while 3 reported progression-free survival. The pooled overall survival HR was 1.41 (0.99-2.02), while the progression-free survival HR was 1.63 (1.09-2.44) for adjuvant vs neoadjuvant therapy. An analysis of adverse effects was not possible.
There were no differences when comparing adjuvant vs. neoadjuvant chemotherapy or adjuvant vs. no intervention chemotherapy. We conclude that progression-free survival had a better response with adjuvant chemotherapy when compared with neoadjuvant therapy. We suggest more studies with adequate design to offer a stronger recommendation.
Urologic oncology. 2022 Mar 17 [Epub ahead of print]
Juan Fernando Paz Rojas, Carlos A Ballestas Almario, Herney Andrés García-Perdomo
Division of Urology, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia., Urology Program, Universidad de Cartagena, Cartagena, Colombia., Division of Urology/Urooncology, Department of Urology, School of Medicine, Universidad del Valle, Cali, Colombia. Electronic address: .