ABSTRACT
Introduction & Objectives: During coronavirus disease 2019 (COVID-19) pandemic, EAU recommended intravesical bacillus Calmette-Guérin (BCG) therapy courses that have been ongoing for longer than 1 year can be safely terminated for high-risk non-muscle-invasive bladder cancer(NMIBC) patients. Thus, we conducted a systematic review and network meta-analysis according to EAU COVID-19 recommendation.Materials & Methods: Systematic review was performed following the PRISMA guideline. PubMed/Medline, EMBASE, and Cochrane Library weresearched up to Sep, 2021. We conducted a network meta-analysis to outcomes including only induction therapy group (No_M), 1-year (M1) andmore than 1 year (MM1) maintenance therapies groups for recurrence rate in patients with NMIBC. Participants, patients with NMIBC;Interventions,NMIBC patients who underwent intravesical BCG therapy;Outcomes, comparison of recurrence rate included for analysis. Quality assessmentswere performed independently by two reviewers using the Scottish Intercollegiate Guidelines Network.Results: Nineteen studies with a total of 3,957 patients were included for network meta-analysis. 19 studies were intermediate risk for detectionbias and there were no major problems. There was just two published studies between M1 and MM1. Five studies between No_M and M1 and 12articles between No_M and MM1 were identified. In node-split forest plot using Bayesian Markov Chain Monte Carlo (MCMC) modeling, there couldbe no difference between M1 and MM1 in recurrence rate (OR 0.95 (0.73-1.2)). However, recurrence rate in No_M group was higher than M1 (OR1.9 (1.5-2.5)) and MM1 (OR 2.0 (1.7-2.4)) groups (Fig. 1A). P-score test using frequentist method to rank treatments in network demonstrate MM1(P-score 0.8701) was superior to M1 (P-score 0.6299) and No_M groups (P-score 0). In the rank-probability test using MCMC modeling, MM1 had the highest rank, followed by M1 and No_M groups (Fig. 1B). (Figure Presented)(Figure Presented)Conclusions: In network meta-analysis, there could be no difference between 1-year and more than 1-year maintenance intravesical BCGtherapies in recurrence rate. In the rank test, more than 1-year therapy could be most effective. During COVID-19 pandemic, 1-year maintenancetherapy can be performed, however, after the COVID-19 pandemic, more than 1-year therapy will be decided