Share
array:24 [ "pii" => "S2173578622001421" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2022.12.003" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1489" "copyright" => "AEU" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2023;47:92-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480622001164" "issn" => "02104806" "doi" => "10.1016/j.acuro.2022.03.007" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1489" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2023;47:92-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Efecto de la mitomicina en comparación con la gemcitabina intravesical en el tratamiento del cáncer de vejiga sin invasión muscular: metaanálisis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "98" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effect of intravesical mitomycin compared with gemcitabine on the treatment non-muscle invasive bladder cancer: A meta-analysis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figura 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 472 "Ancho" => 2508 "Tamanyo" => 126695 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Diagrama de bosque de los daños en las funciones hepática y renal en sujetos con cáncer de vejiga no músculo-invasivo tratados con mitomicina en comparación con gemcitabina intravesical.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "W. Cheng, Y. Zhou, X. Chu, S. Huang, X. Zheng, H. Zheng" "autores" => array:6 [ 0 => array:2 [ "nombre" => "W." "apellidos" => "Cheng" ] 1 => array:2 [ "nombre" => "Y." "apellidos" => "Zhou" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Chu" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Huang" ] 4 => array:2 [ "nombre" => "X." "apellidos" => "Zheng" ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Zheng" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578622001421" "doi" => "10.1016/j.acuroe.2022.12.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622001421?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480622001164?idApp=UINPBA00004N" "url" => "/02104806/0000004700000002/v1_202303021312/S0210480622001164/v1_202303021312/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578622000798" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2022.08.004" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1488" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2023;47:99-103" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "The factors that cause penile shortening after plication surgery in patients with congenital penile curvature" "subtitulo" => "[[es]]Los factores causantes del acortamiento de pene después de la cirugía con plicatura en pacientes con incurvación peneana congénita" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "99" "paginaFinal" => "103" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Sahin, C. Yesildal" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Sahin" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Yesildal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480622001152" "doi" => "10.1016/j.acuro.2021.12.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480622001152?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622000798?idApp=UINPBA00004N" "url" => "/21735786/0000004700000002/v3_202310271248/S2173578622000798/v3_202310271248/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578622000932" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2022.08.018" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1490" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2023;47:87-91" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Safety and efficacy of Rezūm™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezūm® en pacientes con disfunción eréctil con y sin prótesis de pene inflable" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "91" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joshua S. Jue, Jean-Francois Eid" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Joshua S." "apellidos" => "Jue" ] 1 => array:2 [ "nombre" => "Jean-Francois" "apellidos" => "Eid" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480622001176" "doi" => "10.1016/j.acuro.2022.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480622001176?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622000932?idApp=UINPBA00004N" "url" => "/21735786/0000004700000002/v3_202310271248/S2173578622000932/v3_202310271248/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effect of intravesical mitomycin compared with gemcitabine on the treatment non-muscle invasive bladder cancer: A meta-analysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "98" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "W. Cheng, Y. Zhou, X. Chu, S. Huang, X. Zheng, H. Zheng" "autores" => array:6 [ 0 => array:2 [ "nombre" => "W." "apellidos" => "Cheng" ] 1 => array:2 [ "nombre" => "Y." "apellidos" => "Zhou" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Chu" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Huang" ] 4 => array:4 [ "nombre" => "X." "apellidos" => "Zheng" "email" => array:1 [ 0 => "zhenghao8678@outlook.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Zheng" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Urology, The Fifth Affiliated Hospital of Sun Yet-sun University, Zhuhai, Guangdong, China" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto de la mitomicina en comparación con la gemcitabina intravesical en el tratamiento del cáncer de vejiga sin invasión muscular: metaanálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 472 "Ancho" => 2508 "Tamanyo" => 123377 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Forest plot of liver and renal function damage in subjects with non-muscle-invasive bladder cancer treated with mitomycin compared to intravesical gemcitabine.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bladder cancer is a very common cancer worldwide, with 430,000 new cases and more than 165,000 deaths reported in 2021.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Transitional cell carcinoma is the leading cause of bladder cancer. There is also adenocarcinoma and squamous cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Bladder cancer is usually associated with frequent urination, blood in the urine, painful urination, or the need to urinate with inability to do so.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The frequency of bladder cancer in men and women is 3.4% and 1.2%, respectively. However, in subjects aged over 70 years, the frequency of bladder cancer is 2 times higher than in subjects aged 55–65 years and the risk is 15–20 times higher than in subjects aged 30–54 years.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to the World Health Organization, there were 132,432 bladder cancer-related deaths worldwide in 2000.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Almost 80% of bladder cancers are non-invasive, limited to the urothelium with a Ta clinical stage, or to the lamina propria with a T1 stage, at onset, which is characterized by carcinoma in situ or flat tumor, Tis stage.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Tumor recurrence after transurethral resection is acknowledged to be the main concern in the management of non-muscle invasive bladder cancer. The mechanisms related to recurrence of non-muscle invasive bladder cancers after transurethral resection are as follows: (1) residual tumor due to incomplete resection; (2) implantation of floating cancer cells in injured bladder areas; (3) new neoplasia due to high level of aggressiveness of the cancer; (4) recurrence in areas of instability of the urothelium<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>; (5) tumor recurrence due to lack of adjuvant treatment; and (6) muscle invasive cancers.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Intravesical chemotherapy has been considered the gold standard treatment in subjects who have received transurethral resection to eliminate and hinder cancer recurrence, stop tumor growth, and prolong patient survival.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Mitomycin is often used in intravesical treatment. In addition, gemcitabine, which is a fairly new pyrimidine analog, with its anticancer effect on different solid cancers, showed to be effective on advanced bladder cancer.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Although mitomycin and gemcitabine have been used as cytotoxic agents that affect DNA integrity, they have different mechanisms of action. Gemcitabine, 2′-deoxy-2′,2′-difluorocytidine, can be initiated after stimulation of deoxycytidine kinase. Its phosphorylated metabolites could alter deoxynucleotide synthesis causing DNA damage and interference with DNA repair.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Mitomycin could be activated inside cancer cells through the development of reducing equivalents, thus influencing replication in cancer cells through the formation of adducts caused by DNA damage.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However, the efficacy and side effects of both agents remain unclear. The aim of the present meta-analysis was to evaluate the effect of intravesical mitomycin compared with gemcitabine in the treatment of non-muscle-invasive bladder cancer.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">The present study was conducted following an established protocol based on meta-analysis of epidemiological studies.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study selection</span><p id="par0015" class="elsevierStylePara elsevierViewall">Included studies had statistical relationship (odds ratio [OR], mean difference [MD], frequency rate or relative risk ratios, with 95% confidence intervals [CI]) comparing between the effect of intravesical mitomycin with gemcitabine in the treatment of non-muscle invasive bladder cancer were included.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Only human studies were selected, and no language restrictions were applied. Inclusion was not limited by study size or type. Exclusion criteria were review articles, commentaries, and studies that did not provide the level of association. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the complete study procedure. Articles were combined in the meta-analysis when the following inclusion criteria were met:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study was a randomized controlled trial, a prospective study, or a retrospective study.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0030" class="elsevierStylePara elsevierViewall">The target population was subjects with non-muscle invasive bladder cancer.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0035" class="elsevierStylePara elsevierViewall">The intervention program was intravesical mitomycin compared with intravesical gemcitabine.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study involved comparisons between mitomycin and intravesical gemcitabine.</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The exclusion criteria were the following:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">1.</span><p id="par0050" class="elsevierStylePara elsevierViewall">Studies that did not determine the effect of mitomycin compared with intravesical gemcitabine in the treatment of non-muscle invasive bladder cancer.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Studies with treatment other than mitomycin and intravesical gemcitabine.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Studies that did not focus on the effect of comparative outcomes.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Identification</span><p id="par0065" class="elsevierStylePara elsevierViewall">A search protocol was developed based on the PICOS principle, defined as follows: P (population) subjects with non-muscle invasive bladder cancer; I (intervention/exposure) intravesical mitomycin compared with gemcitabine; C (comparison) intravesical mitomycin and intravesical gemcitabine; O (outcome) recurrence rates, chemical cystitis, hematuria, skin reaction, and liver and renal function damage; and S (study design) without limitations.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> First, a systematic search was conducted in Embase, PubMed, Cochrane Library, OVID, Google Scholar, the Chinese biomedical literature database, the National Institute for Health and Clinical Excellence, NHS Evidence, the full-text database of Chinese periodicals, and the full-text database of Chinese technology publications until November 2021, using a combination of keywords and related terms for intravesical mitomycin, non-muscle invasive bladder cancer, intravesical gemcitabine, recurrence rates, chemical cystitis, hematuria, skin reaction, and liver and kidney function damage, as shown in Appendix Table 1 of the Supplementary material. All selected studies were pooled into one EndNote file, duplicates were removed, and titles and abstracts were reviewed to eliminate studies showing no association on the effect of intravesical mitomycin and gemcitabine on the outcomes studied for subjects with non-muscle invasive bladder cancer. The resulting studies were analyzed for relevant information.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Screening</span><p id="par0070" class="elsevierStylePara elsevierViewall">The data were summarized according to the following: study-related and subject-related properties in a homogeneous form, i.e., lead author's last name, study period, country, year of publication, study region and population type, study design, total number of subjects, demographics, and clinical and treatment properties. In addition, the evaluation period is related to the measurement, quantitative technique and qualitative evaluation technique, source of information, outcome assessment and statistical analysis MD or relative risk, with 95% CI of the relationship.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> When a study eligible for inclusion depended on the aforementioned principles, data were extracted separately by 2 authors. In case of discrepancies, the corresponding author gave a final assessment. When there were different data from a study based on the assessment of the relationship between the effects of intravesical mitomycin compared with gemcitabine on the outcomes studied for subjects with non-muscle-invasive bladder cancer, they were extracted separately. To assess the risk of bias of these studies 2 authors assessed the procedural quality of the nominated studies independently. The “risk of bias tool” from the RoB 2: A studied Cochrane risk-of-bias tool for randomized trials was used to measure procedural quality. In terms of the evaluation criteria, each study was valued and consigned to one of the next three risks of bias: low: if all quality standards were met, the study was considered to have a low risk of bias; unclear: if one or more of the quality standards were partly met or unclear, the study was considered to have a moderate risk of bias; or high: if one or more of the standards were not met, or not comprised, the study was considered to have a high risk of bias. Any discrepancies were addressed by reviewing the original article.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Eligibility</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main outcome concerned the effect of intravesical mitomycin compared with gemcitabine in the treatment of non-muscle invasive bladder cancer. An evaluation of the effect of intravesical mitomycin and gemcitabine on recurrence rates, chemical cystitis, hematuria, skin reaction, and liver and kidney function damage in non-muscle invasive bladder cancer was extracted for summary.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Inclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Sensitivity analyses were limited only to studies showing the association of the effect of intravesical mitomycin compared with gemcitabine in the treatment of non-muscle invasive bladder cancer. For subgroup and sensitivity analysis, a comparison between intravesical mitomycin and intravesical gemcitabine was performed.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">The odds ratio (OR) and 95% CI were calculated using the dichotomous technique with a fixed or random effects model. The I2 index was calculated and ranged from 0% to 100%. When the I2 index was around 0%, 25%, 50%, 50%, and 75%, zero, low, moderate, and high heterogeneity were identified, respectively. If the I2 was<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>50%, the random effect was used; if it was<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50%, the fixed effect was used. To perform the subgroup analysis, the stratification of the original calculation by outcome category, as defined above, was used. A p-value for differences between subgroups of<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 reflected a statistically significant difference. Study bias was measured quantitatively by Egger's regression test (study bias is present if p<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>0.05), and qualitatively, by visual examination of funnel plots of the logarithm of the ORs versus their standard errors. All p values were 2-tailed. Reviewer Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used to perform all measurements and graphs.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 501 different studies were found, of which 6 studies (between 2010 and 2021) met the inclusion criteria and were included in the study.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–18</span></a> These studies included 389 subjects with non-muscle invasive bladder cancer at baseline; 197 of them received intravesical mitomycin and 192 intravesical gemcitabine. All studies evaluated the effect of intravesical mitomycin compared with gemcitabine in the treatment of non-muscle invasive bladder cancer.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The size of the studies ranged from 28 to 109 subjects with non-muscle invasive bladder cancer at baseline. Data from the 6 studies are shown in Appendix Table 2 of the Supplementary material. Data was stratified according to recurrence rates in six studies, chemical cystitis in 4 studies, hematuria in 5 studies, skin reaction in 2 studies, and liver and renal function damage in 2 studies.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Intravesical mitomycin had significantly higher rates of recurrence (OR: 2.41; 95% CI: 1.43–4.08; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) without heterogeneity (I2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%) and chemical cystitis (OR: 4.39; 95% CI: 2.27–8.51; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) without heterogeneity (I2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%) compared with intravesical gemcitabine in subjects with non-muscle invasive bladder cancer, as shown in <a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>. However, the effect of intravesical mitomycin was not significantly different in terms of hematuria (OR: 1.71; 95% CI: 0.68–4.33; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.26) without heterogeneity (I2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%), skin reaction (OR: 2.04; 95% CI: 0.59–7.07; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.26) without heterogeneity (I2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%) and damage to liver and kidney functions (OR: 1.96, 95% CI: 0.35–10.96, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.44) with low heterogeneity (I2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48%) compared with intravesical gemcitabine in subjects with non-muscle invasive bladder cancer, as shown in <a class="elsevierStyleCrossRefs" href="#fig0020">Figs. 4–6</a>. Stratified analysis of studies adjusted for sex, ethnicity, and age was not completed because no study reported or adjusted for these influences.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Based on visual assessment of the funnel plot, as well as quantitative measurement using Egger's regression test, there was no indication of publication bias (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.87). However, most included studies were of low procedural quality due to their small sample size. Not all studies had selective reporting bias, and no studies had incomplete outcome data and selective reporting.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This meta-analysis study based on 6 studies included 389 subjects with non-muscle invasive bladder cancer at the start of the study; 197 of them were provided with intravesical-mitomycin and 192 were intravesical gemcitabine.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–18</span></a> Intravesical-mitomycin had significantly higher recurrence rates and chemical cystitis compared to intravesical-gemcitabine in subjects with non-muscle invasive bladder cancer. However, intravesical-mitomycin had no significant difference in its effect on the hematuria, skin reaction, and liver and kidney functions damage compared to intravesical-gemcitabine in subjects with non-muscle invasive bladder cancer. Yet, the analysis of results must be done with attention due to the low number of selected studies and the low sample size of most of the selected studies found for the meta-analysis, 5 out of 6 studies with less than 100 subjects as sample size; recommending the necessity for additional studies to confirm these findings or perhaps to significantly impact confidence in the effect assessment.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Non-muscle invasive bladder cancers are usually related to favorable clinical results, but it is refractory because of the high tumor relapse rate after transurethral resection. Up to 85% of the patients develop tumor relapse in 2–5 years after transurethral resection, while almost 10% of the relapse subjects are at the more advanced grades and stages.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In clinical practice, transurethral resection is done before intravesical injection, to decrease the bladder cancer relapse and growth. Different anti-cancer agents are administered intravesically to prevent cancer relapse, which is confirmed effective. The classical intravesical agents, Bacille Calmette-Guérin and mitomycin are effective in delaying and decreasing postoperative cancer relapse; however, they are also related to clear adverse reactions and might be ineffective in some cases. Gemcitabine was found to be effective in decreasing the relapse of non-muscle invasive bladder cancer with lower toxicity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> For low-risk cancer, post-operative intravesical-mitomycin management is still an important part of intravesical treatment, in the meantime, there is level-one evidence showing the efficacy of gemcitabine on bladder cáncer.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> This was obvious in Addeo et al. study.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Subjects using gemcitabine are usually higher-risk tumors. For example, the Addeo study has 80% of patients who had previously been treated with BCG. In these patients, mitomycin probably has less effect than gemcitabine.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Several therapeutic techniques are effective in the management of non-muscle invasive bladder cancers. The intravesical chemotherapy using mitomycin and gemcitabine has achieved favorable outcomes.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Gemcitabine is an effective pyrimidine antimetabolite, with mild toxicity compared to other chemotherapeutic agents.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Messing EM et al. found that for the low-grade non-muscle invasive bladder cancers, those who received intravesical-gemcitabine management after transurethral resection were related to the 4-year cancer relapse rate much lower than those who received saline-alone.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Also, a lower number of cases progressed to muscle-invasive bladder cancer or died with gemcitabine compared to saline alone.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Dalbagni et al. found that for the Bacille Calmette-Guérin-refractory non-muscle invasive bladder cancers who received intravesical-gemcitabine management, 50% accomplished a complete response, and adverse effects were found in 23% of them with very low toxicity.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Also, Bartoletti et al. found that no 1-year cancer relapse was found in most of his medium-risk subjects studied, and high-risk Bacille Calmette-Guérin-refractory managed with weekly intravesical-gemcitabine treatment. They also found no side effects for most of their subjects in the 1-year management.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Jones et al. studied 6 gemcitabine management-associated randomized controlled trials in their Cochrane review and showed that intravesical-gemcitabine management possibly exerted a vital role in treating non-muscle invasive bladder cancers, mainly when it was adopted to be the substitute to mitomycin for high-risk patients.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Supplementary intravesical management could decrease the relapse and progress rates of non-muscle invasive bladder cancers and induce local and systemic adverse reactions. Chemical cystitis, hematuria, skin reaction, and liver and kidney functions damage were detected in up to 30%. The incidence of these side effects in the gemcitabine arm was much lower compared with that found in the mitomycin arm.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Gemcitabine causes minimal local toxicity, which self-resolves rapidly. Though, mitomycin management caused more serious local toxicity. The economic effect is an additional factor that would possibly influence the management decision. Lately, the price for 40<span class="elsevierStyleHsp" style=""></span>mg mitomycin has increased compared with that for 2<span class="elsevierStyleHsp" style=""></span>g gemcitabine, recommending that the gemcitabine-dependent intravesical chemotherapy would be cost-effective compared with mitomycin.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> However, the most important limitation of the study was the different doses or regimens used for both treatments of the selected studies, due to the low number of studies found we could not compare. Given the importance of this topic, it should be mentioned that oncological outcomes may be influenced by it and need further studies.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Intravesical-mitomycin had significantly higher recurrence and chemical cystitis rates compared to intravesical-gemcitabine in subjects with non-muscle invasive bladder cancer. However, intravesical-mitomycin had no significant difference in its effect on the hematuria, skin reaction, and liver and kidney functions damage compared to intravesical-gemcitabine in subjects with non-muscle invasive bladder cancer. Further studies are required to validate these findings.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1999081" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1713368" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1999080" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1713367" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study selection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Identification" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Screening" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Eligibility" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Inclusion" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-12-14" "fechaAceptado" => "2022-03-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1713368" "palabras" => array:6 [ 0 => "Intravesical mitomycin" 1 => "Non-muscle invasive bladder cancer" 2 => "Intravesical gemcitabine" 3 => "Recurrence rates" 4 => "Chemical cystitis" 5 => "Hematuria" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1713367" "palabras" => array:6 [ 0 => "Mitomicina intravesical" 1 => "Cáncer de vejiga sin invasión muscular" 2 => "Gemcitabina intravesical" 3 => "Tasas de recurrencia" 4 => "Cistitis química" 5 => "Hematuria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We performed a meta-analysis to evaluate the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A systematic literature search up to November 2021 was done and 6 studies included 389 subjects with non-muscle invasive bladder cancer at the start of the study; 197 of them were provided with intravesical-mitomycin and 192 with intravesical gemcitabine. The studies reported the relationships about the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer using the dichotomous method with a random or fixed-effect model.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Intravesical mitomycin had significantly higher recurrence rates (OR, 2.41; 95% CI, 1.43–4.08, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) and chemical cystitis (OR, 4.39; 95% CI, 2.27–8.51, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. However, intravesical mitomycin had no significant difference in its effect on hematuria (OR, 1.71; 95% CI, 0.68–4.33, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.26), skin reaction (OR, 2.04; 95% CI, 0.59–7.07, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.26), and liver and kidney functions damage (OR, 1.96; 95% CI, 0.35–10.96, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.44) compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Intravesical mitomycin had significantly higher recurrence rates and chemical cystitis and no significant difference in its effect on hematuria, skin reaction, and liver and kidney functions damage compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. Further studies are required to validate these findings.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se realizó un metaanálisis para evaluar el efecto de la mitomicina intravesical en comparación con la gemcitabina en el tratamiento del cáncer de vejiga sin invasión muscular.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se realizó una búsqueda bibliográfica sistemática hasta noviembre de 2021 y 6 estudios incluyeron 389 sujetos con cáncer de vejiga no invasivo al músculo al inicio del estudio; 197 de ellos recibieron mitomicina intravesical y 192<span class="elsevierStyleHsp" style=""></span>gemcitabina intravesical. Se informó de las relaciones sobre el efecto de la mitomicina intravesical en comparación con la gemcitabina en el tratamiento del cáncer de vejiga no invasivo al músculo. Se calculó el odds ratio (OR) con intervalos de confianza (IC) del 95% para evaluar el efecto de la mitomicina en comparación con el de la gemcitabina intravesical en el tratamiento del cáncer de vejiga no invasivo mediante el método dicotómico con un modelo de efectos aleatorios o fijos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La mitomicina intravesical obtuvo tasas significativamente mayores de recidiva (OR, 2,41; IC del 95%, 1,43–4,08, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001) y de cistitis química (OR, 4,39; IC del 95%, 2,27–8,51, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) en comparación con la gemcitabina intravesical en sujetos con cáncer de vejiga no invasivo. Sin embargo, la mitomicina intravesical no mostró diferencias significativas en su efecto sobre la hematuria (OR, 1,71; IC del 95%, 0,68–4,33, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,26), reacciones cutáneas (OR, 2,04; IC del 95%, 0,59–7,07, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,26) y daños en la función hepática y renal (OR, 1,96; IC del 95%, 0,35–10,96, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,44) en comparación con la gemcitabina intravesical en sujetos con cáncer de vejiga no invasivo al músculo.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La mitomicina intravesical tuvo tasas de recidiva y cistitis química significativamente mayores y no hubo diferencias significativas en su efecto sobre la hematuria, la reacción cutánea y el daño de la función hepática y renal en comparación con la gemcitabina intravesical en sujetos con cáncer de vejiga no invasivo al músculo. Se necesitan más estudios para validar estos resultados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0135" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0070" ] ] ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 2508 "Tamanyo" => 286843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic illustration of the study method.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 668 "Ancho" => 2508 "Tamanyo" => 163149 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forest plot of recurrence rates in subjects with non-muscle invasive bladder cancer treated with mitomycin compared to intravesical treatment with gemcitabine.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 573 "Ancho" => 2508 "Tamanyo" => 155153 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0085" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forest plot of chemical cystitis in subjects with non-muscle-invasive bladder cancer treated with mitomycin compared to intravesical gemcitabine.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 625 "Ancho" => 2508 "Tamanyo" => 167778 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Forest plot of hematuria in subjects with non-muscle-invasive bladder cancer treated with mitomycin compared to intravesical gemcitabine.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 476 "Ancho" => 2508 "Tamanyo" => 122754 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Forest plot of skin reaction in subjects with non-muscle-invasive bladder cancer treated with mitomycin compared to intravesical gemcitabine.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 472 "Ancho" => 2508 "Tamanyo" => 123377 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Forest plot of liver and renal function damage in subjects with non-muscle-invasive bladder cancer treated with mitomycin compared to intravesical gemcitabine.</p>" ] ] 6 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 24885 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bladder cancer incidence and mortality: a global overview and recent trends" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Antoni" 1 => "J. Ferlay" 2 => "I. Soerjomataram" 3 => "A. Znaor" 4 => "A. Jemal" 5 => "F. Bray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2016.06.010" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2017" "volumen" => "71" "paginaInicial" => "96" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27370177" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathobiology and chemoprevention of bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Tanaka" 1 => "K. Miyazawa" 2 => "T. Tsukamoto" 3 => "T. Kuno" 4 => "K. Suzuki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Oncol" "fecha" => "2011" "volumen" => "2011" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiplexed methylation profiles of tumor suppressor genes in bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Cabello" 1 => "L. Grau" 2 => "N. Franco" 3 => "E. Orenes" 4 => "M. Alvarez" 5 => "A. Blanca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Molecular Diagnostics" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "29" "paginaFinal" => "40" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer incidence, mortality and prevalence worldwide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Ferlay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "GLOBOCAN2002" "fecha" => "2004" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of intravesical chemoimmunotherapy with epirubicin and bacillus Calmette-Guerin for prophylaxis of recurrence of superficial bladder cancer: a preliminary report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Uekado" 1 => "A. Hirano" 2 => "T. Shinka" 3 => "T. Ohkawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF00686923" "Revista" => array:6 [ "tituloSerie" => "Cancer Chemother Pharmacol" "fecha" => "1994" "volumen" => "35" "paginaInicial" => "S65" "paginaFinal" => "S68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7994790" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Approaches to reducing recurrence in superficial bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.R. Ray" 1 => "T.S. O’Brien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Kidney Urol Dis" "fecha" => "2006" "volumen" => "1" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An overview of intravesical therapy for superficial bladder tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.W. Herr" 1 => "V.P. Laudone" 2 => "W.F. Whitmore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0022-5347(17)43644-5" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1987" "volumen" => "138" "paginaInicial" => "1363" "paginaFinal" => "1368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3316712" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The treatment of non–muscle-invasive bladder cancer with intravesical chemotherapy and immunotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Whelan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Urol Suppl" "fecha" => "2007" "volumen" => "6" "paginaInicial" => "568" "paginaFinal" => "571" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase II study of single-agent gemcitabine in previously untreated patients with metastatic urothelial cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.M. Stadler" 1 => "T. Kuzel" 2 => "B. Roth" 3 => "D. Raghavan" 4 => "F.A. Dorr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1997" "volumen" => "15" "paginaInicial" => "3394" "paginaFinal" => "3398" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gemcitabine: preclinical pharmacology and mechanisms of action" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Plunkett" 1 => "P. Huang" 2 => "C.E. Searcy" 3 => "V. Gandhi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Oncol" "fecha" => "1996" "volumen" => "23" "paginaInicial" => "3" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8893876" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Second-line intravesical therapy versus cystectomy for bacille Calmette-Guerin (BCG) failures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.N. Joudi" 1 => "M.A. O’Donnell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00042307-200409000-00005" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Urol" "fecha" => "2004" "volumen" => "14" "paginaInicial" => "271" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15300147" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity is independently associated with increased risk of hepatocellular cancer-related mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gupta" 1 => "A. Das" 2 => "K. Majumder" 3 => "N. Arora" 4 => "H.G. Mayo" 5 => "P.P. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/COC.0000000000000388" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Oncol" "fecha" => "2018" "volumen" => "41" "paginaInicial" => "874" "paginaFinal" => "881" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28537989" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized phase III trial on gemcitabine versus mytomicin in recurrent superficial bladder cancer: evaluation of efficacy and tolerance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Addeo" 1 => "M. Caraglia" 2 => "S. Bellini" 3 => "A. Abbruzzese" 4 => "B. Vincenzi" 5 => "L. Montella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2008.20.8199" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "543" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19841330" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical effect of antineoplastic drug perfusion in preventing postoperative recurrence of superficial bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Z. Xiaohong" 1 => "J. Tan" 2 => "Y. Wei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Chin Physician" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "1043" "paginaFinal" => "1045" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of the efficacy of different chemotherapy drugs in the prevention of postoperative recurrence in superficial bladder cancer by intravesical instillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Lin" 1 => "L. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "China Foreign Med Treat" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "118" "paginaFinal" => "119" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of intravesical perfusion of gemcitabine and mitomycin after non-muscle invasive bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Sun" 1 => "R. Liu" 2 => "H. Zhao" 3 => "B. Wang" 4 => "Y. Liu" 5 => "K. Wen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Med Theory Pract" "fecha" => "2016" "volumen" => "29" "paginaInicial" => "3238" "paginaFinal" => "3239" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Curative effect analysis of different chemotherapeutics at intravesical instillation in the prevention of tumor recurrence after TUR-Bt" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "X. Dong" 1 => "L. Song" 2 => "F. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Zhejiang J Traumat Surg" "fecha" => "2017" "volumen" => "22" "paginaInicial" => "109" "paginaFinal" => "110" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravesical gemcitabine and mitomycin C chemotherapy in the treatment of non muscle invasive transitional cell carcinoma of urinary bladder—a randommized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Alam" 1 => "S. Morshed" 2 => "S.M.W. Uddin" 3 => "P.K. Saha" 4 => "S. Rahman" 5 => "R.B. Sumee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Bangladesh J Urol" "fecha" => "2019" "volumen" => "22" "paginaInicial" => "25" "paginaFinal" => "29" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on intravesical agents for non-muscle-invasive bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.F. Shariat" 1 => "D.C. Chade" 2 => "P.I. Karakiewicz" 3 => "D.S. Scherr" 4 => "G.U. Dalbagni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/imt.10.1" "Revista" => array:7 [ "tituloSerie" => "Immunotherapy" "fecha" => "2010" "volumen" => "2" "numero" => "3" "paginaInicial" => "381" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20635902" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravesical gemcitabine therapy for non‐muscle invasive bladder cancer (NMIBC): a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.D. Shelley" 1 => "G. Jones" 2 => "A. Cleves" 3 => "T.J. Wilt" 4 => "M.D. Mason" 5 => "H.G. Kynaston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2011.10880.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2012" "volumen" => "109" "paginaInicial" => "496" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22313502" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of intravesical instillation of gemcitabine vs saline immediately following resection of suspected low-grade non–muscle-invasive bladder cancer on tumor recurrence: SWOG S0337 randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.M. Messing" 1 => "C.M. Tangen" 2 => "S.P. Lerner" 3 => "D.M. Sahasrabudhe" 4 => "T.M. Koppie" 5 => "D. Wood Jr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2018.4657" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2018" "volumen" => "319" "paginaInicial" => "1880" "paginaFinal" => "1888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29801011" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase II trial of intravesical gemcitabine in bacille Calmette-Guérin–refractory transitional cell carcinoma of the bladder" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Dalbagni" 1 => "P. Russo" 2 => "B. Bochner" 3 => "L. Ben-Porat" 4 => "J. Sheinfeld" 5 => "P. Sogani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2005.05.2720" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "2729" "paginaFinal" => "2734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16782913" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravesical gemcitabine therapy for superficial transitional cell carcinoma: results of a phase II prospective multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Bartoletti" 1 => "T. Cai" 2 => "M. Gacci" 3 => "G. Giubilei" 4 => "F. Viggiani" 5 => "G. Santelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2005.04.062" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2005" "volumen" => "66" "paginaInicial" => "726" "paginaFinal" => "731" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16230125" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravesical mitomycin C for superficial transitional cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Bolenz" 1 => "Y. Cao" 2 => "M.F. Arancibia" 3 => "L. Trojan" 4 => "P. Alken" 5 => "M.S. Michel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Exp Rev Anticancer Ther" "fecha" => "2006" "volumen" => "6" "paginaInicial" => "1273" "paginaFinal" => "1282" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravesical gemcitabine for non-muscle invasive bladder cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Jones" 1 => "A. Cleves" 2 => "T.J. Wilt" 3 => "M. Mason" 4 => "H.G. Kynaston" 5 => "M. Shelley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2012" "volumen" => "1" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Centers for Medicare & Medicaid Services. 2020 ASP Drug Pricing Files. [Accessed 12 December 2021]. Available from: <a target="_blank" href="https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/2020-asp-drug-pricing-files">https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/2020-asp-drug-pricing-files</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004700000002/v3_202310271248/S2173578622001421/v3_202310271248/en/main.assets" "Apartado" => array:4 [ "identificador" => "6274" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004700000002/v3_202310271248/S2173578622001421/v3_202310271248/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622001421?idApp=UINPBA00004N" ]
