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Article Open Access

Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer

  • Authors:
    • Xiaoxi Liu
    • Yige Bao
  • View Affiliations / Copyright

    Affiliations: Operating Room, West China Hospital, Sichuan University Chengdu, Sichuan 610041, P.R. China
    Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 288
    |
    Published online on: May 8, 2026
       https://doi.org/10.3892/ol.2026.15643
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Abstract

Intravesical Bacillus Calmette‑Guerin (BCG) is the first‑line therapy for non‑muscle‑invasive bladder cancer (NMIBC), yet its clinical use is limited by high adverse event rates and a global supply shortage. A comparison was conducted to explore the effectiveness of low‑ vs. standard‑dose BCG vaccines in patients diagnosed with NMIBC). The search queries utilized for China National Knowledge Infrastructure and Wanfang databases included the key words ‘dose’, ‘BCG vaccine’ and ‘bladder cancer/bladder tumour’. Embase, PubMed and Web of Science databases were searched using the key words ‘dose’, ‘Bacillus Calmette‑Guerin vaccine’ and ‘urinary bladder neoplasm’ to identify randomized controlled trials published up to December 2024. The relevant data were collected from the included study articles and a meta‑analysis was conducted utilizing the Review Manager 5.4 software to evaluate the therapeutic effects of low‑ and standard‑dose BCG vaccines. In total, 13 studies were included in the present meta‑analysis after literature search, selection process and quality assessment. The present meta‑analysis findings suggested that the recurrence rate in patients receiving low‑dose therapy was notably higher compared with that in patients receiving standard‑dose therapy [odds ratio (OR)=1.38; 95% CI, 1.10‑1.73; P=0.006]. However, the incidence of adverse events was lower compared with that in the standard‑dose treatment group (OR=0.39; 95% CI, 0.29‑0.52; P<0.00001) and no marked differences in tumour progression, tumour‑specific or overall mortalities were detected between the two groups (all P>0.05). The funnel plot revealed no notable publication bias. In conclusion, the present meta‑analysis confirmed the effectiveness of low‑dose BCG treatment for patients with NMIBC and highlighted its potentially notable advantage in managing adverse events in patients with NMIBC in the future.
View Figures

Figure 1

Flowchart of study selection. CNKI,
China National Knowledge Infrastructure.

Figure 2

Quality evaluation of included
randomized controlled trials. The 13 included studies were
evaluated using the Cochrane Risk of Bias tool (A) Risk of bias
graph. (B) Risk of bias summary). Green, low risk of bias; yellow
dots indicate unclear risk of bias; Red dots indicate high risk of
bias.

Figure 3

Forest plot of tumour recurrence.
Dots represent the individual effect size (OR) of each included
study.

Figure 4

Forest plot of the meta-analysis for
tumour progression. Colored data points in the plot represent the
individual effect size (OR) of each included study.

Figure 5

Forest plot of the meta-analysis for
tumour-specific survival. Colored data points in the plot represent
the individual effect size (OR) of each included study.

Figure 6

Forest plot of the meta-analysis for
overall mortality. Colored data points in the plot represent the
individual effect size (OR) of each included study.

Figure 7

Forest plot of the meta-analysis for
adverse events. Colored data points in the plot represent the
individual effect size (OR) of each included study.

Figure 8

Publication bias. OR, odds ratio.
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Copy and paste a formatted citation
Spandidos Publications style
Liu X and Bao Y: Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer. Oncol Lett 32: 288, 2026.
APA
Liu, X., & Bao, Y. (2026). Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer. Oncology Letters, 32, 288. https://doi.org/10.3892/ol.2026.15643
MLA
Liu, X., Bao, Y."Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer". Oncology Letters 32.1 (2026): 288.
Chicago
Liu, X., Bao, Y."Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer". Oncology Letters 32, no. 1 (2026): 288. https://doi.org/10.3892/ol.2026.15643
Copy and paste a formatted citation
x
Spandidos Publications style
Liu X and Bao Y: Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer. Oncol Lett 32: 288, 2026.
APA
Liu, X., & Bao, Y. (2026). Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer. Oncology Letters, 32, 288. https://doi.org/10.3892/ol.2026.15643
MLA
Liu, X., Bao, Y."Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer". Oncology Letters 32.1 (2026): 288.
Chicago
Liu, X., Bao, Y."Meta‑analysis of efficacy comparisons between standard‑ and low‑dose Bacillus Calmette‑Guerin vaccines in managing non‑muscular invasive bladder cancer". Oncology Letters 32, no. 1 (2026): 288. https://doi.org/10.3892/ol.2026.15643
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