围手术期恩诺单抗维多汀-帕博利珠单抗、吉西他滨-顺铂-度伐利尤单抗和剂量密集型MVAC用于适合顺铂的肌层浸润性膀胱癌：一项获益-风险贝叶斯网络荟萃分析。
完整摘要 · 中文译文
为了比较三种围手术期方案在适合顺铂的肌层浸润性膀胱癌（MIBC）中的疗效和安全性：恩诺单抗维多汀联合帕博利珠单抗（EV + P）、吉西他滨-顺铂联合度伐利尤单抗（GC + Durva）和剂量密集型MVAC（dd-MVAC）；在缺乏头对头试验的情况下，采用贝叶斯网络荟萃分析（NMA）。通过截至2026年3月的系统性检索，确定了比较围手术期方案与吉西他滨-顺铂（GC）用于适合顺铂MIBC的III期临床试验。主要分析是对无事件生存期（EFS）、总生存期（OS）和病理学完全缓解（pCR）进行的贝叶斯NMA，并进行SUCRA排序；偏倚风险采用RoB-2。三项试验（EV-304、NIAGARA、VESPER；2364例患者）形成了以GC为对照的星形网络；所有方案均改善了EFS——EV + P（风险比[HR] 0.53，95%置信区间[CI] 0.41-0.70）、GC + Durva（0.68，0.56-0.82）、dd-MVAC（0.74，0.55-0.99）——以及OS——EV + P（0.65，0.48-0.89）、GC + Durva（0.75，0.60-0.93）、dd-MVAC（0.71，0.52-0.97）。EV + P在所有终点均排名第一（SUCRA：EFS 96%，OS 81%，pCR > 99%）。实验方案之间的间接比较在生存方面无显著性差异；仅在pCR方面EV + P优于GC + Durva（比值比[OR] 1.7，P < 0.01）和dd-MVAC（OR 2.0，P < 0.01）。GC + Durva与GC相比未显示≥3级毒性增加（41% vs. 41%）。该NMA为这些方案提供了首个整合疗效排序、毒性和亚组异质性的定量获益-风险框架。EV + P在改善EFS、OS和pCR方面具有最高概率，GC + Durva排名第二；尽管 d 与每项试验的方向一致，但若不经间接汇总，则无法量化其幅度、排序和亚组异质性。GC + Durva 提供了最有利的获益-风险特征。前瞻性头对头试验仍是一项未满足的需求。
完整摘要 · 英文原文
To compare the efficacy and safety of three perioperative regimens for cisplatin-eligible muscle-invasive bladder cancer (MIBC); enfortumab vedotin plus pembrolizumab (EV + P), gemcitabine-cisplatin plus durvalumab (GC + Durva), and dose-dense MVAC (dd-MVAC), in the absence of head-to-head trials, using a Bayesian network meta-analysis (NMA). A systematic search through March 2026 identified phase III trials comparing perioperative regimens against GC in cisplatin-eligible MIBC. The primary analysis was a Bayesian NMA of event-free survival (EFS), overall survival (OS), and pathological complete response (pCR), with SUCRA rankings; risk of bias used RoB-2. Three trials (EV-304, NIAGARA, VESPER; 2,364 patients) formed a star-shaped network vs. GC, all regimens improved EFS-EV + P (Hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.41-0.70), GC + Durva (0.68, 0.56-0.82), dd-MVAC (0.74, 0.55-0.99), and OS, EV + P (0.65, 0.48-0.89), GC + Durva (0.75, 0.60-0.93), dd-MVAC (0.71, 0.52-0.97). EV + P ranked first across all endpoints (SUCRA: EFS 96%, OS 81%, pCR > 99%). Indirect comparisons between experimental regimens were non-significant for survival; only pCR favored EV + P over GC + Durva (odds ratio [OR] 1.7, P < 0.01) and dd-MVAC (OR 2.0, P < 0.01). GC + Durva showed no excess Grade ≥3 toxicity over GC (41% vs. 41%). This NMA provides the first quantitative benefit-risk framework integrating efficacy ranking, toxicity, and subgroup heterogeneity for these regimens. EV + P had the highest probability of improving EFS, OS, and pCR, with GC + Durva ranking second; although directionally consistent with each trial, the magnitude, ranking, and subgroup heterogeneity could not be quantified without indirect synthesis. GC + Durva offered the most favorable benefit-risk profile. Prospective head-to-head trials remain an unmet need.