| Quality assessment | No of patients | Effect | Quality | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Gemcitabine | Control | Relative (95% CI) | Absolute | |
| Overall survival | |||||||||||
| 41 | observational studies | none | none | serious2 | serious8 | none | N=133 3 | - | - | - | ⊕○○○ VERY LOW |
| Progression-free survival | |||||||||||
| 34 | observational studies | none | none | serious2 | serious8 | none | N=119 5 | - | - | - | ⊕○○○ VERY LOW |
| Overall tumour response (assessed with: WHO criteria) | |||||||||||
| 41 | observational studies | none | none | serious2 | serious8 | none | 28/127 (22%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Neutropenia | |||||||||||
| 26 | observational studies | none | none | serious2 | serious8 | none | 29/79 (36.7%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Thrombocytopenia | |||||||||||
| 41 | observational studies | none | none | serious2 | serious8 | none | 11/131 (8.4%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Anaemia | |||||||||||
| 41 | observational studies | none | none | serious2 | serious8 | none | 16/131 (12.2%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Leucopenia | |||||||||||
| 41 | observational studies | none | none | serious2 | serious8 | none | 29/131 (22.1%) | - | - | - | ⊕○○○ VERY LOW |
| Treatment-related mortality | |||||||||||
| 17 | observational studies | none | none | serious2 | serious8 | none | 0/44 (0%) | - | - | - | |
| Health-related quality of life (measured with: Spitzer pain index; Better indicated by lower values) | |||||||||||
| 19 | observational studies | none | none | serious2 | serious8 | none | 2510 | - | - | ⊕○○○ VERY LOW | |
Adjuvant and neoadjuvant chemotherapy considered as first-line chemotherapy;
Median overall survival ranged from 5 months to 13 months across studies;
Median progression-free survival ranged from 3.1 months to 4.9 months;
Lorusso 1997, Akaza 2007;
Small sample size and/or low number of events limit the precision of this outcome;
Non-responders showed a decrease in pain values from 5.3 to 4.8 which corresponds to an increase in pain during treatment. Responders showed an improvement in pain values from 4.3 to 5.8 (p<0.05).
From: 5, Managing locally advanced or metastatic bladder cancer
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