Open Access Highly Accessed Research article

Optimal schedule of bacillus calmette-guerin for non-muscle-invasive bladder cancer: a meta-analysis of comparative studies

Shimiao Zhu1, Yang Tang1, Kai Li2, Zhiqun Shang1, Ning Jiang1, Xuewu Nian1, Libin Sun1 and Yuanjie Niu1*

Author Affiliations

1 Department of Urology, Tianjin Institute of Urology, 2nd Hospital of Tianjin Medical University, Pingjiang Road 23, Tianjin, People’s Republic of China

2 Department of Urology, Tianjin Third Central Hospital, Tianjin, People’s Republic of China

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BMC Cancer 2013, 13:332  doi:10.1186/1471-2407-13-332

Published: 5 July 2013



To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).


Comprehensive searches of electronic databases (PubMed, Embase, and the Cochrane Library) were performed, then a systematic review and cumulative meta-analysis of 21 randomized controlled trials (RCTs) and 9 retrospective comparative studies were carried out according to predefined inclusion criteria.


Significantly better recurrence-free survivals (RFS) were observed respectively in patients who received BCG maintenance, standard-dose and BCG plus epirubicin therapy comparing to those received induction, low-dose and BCG alone. BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events. Pooled results showed no remarkable advantage of BCG combined with Mitomycin C or with interferon α-2b in improving oncologic outcomes. Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity. Our data confirmed that non-RCT only affected strength rather than direction of the overall results.


All patients with superficial BCa should be encouraged to accept BCG maintenance therapy with standard-dose if well tolerated. Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.

Bacillus Calmette-Guérin; Non-muscle-invasive bladder cancer; Maintenance therapy; Low-dose; Combination therapy; Prognosis