Abstract
ContextCompared with white light imaging (WLI) cystoscopy, narrow band imaging (NBI) cystoscopy could increase the visualization and detection of bladder cancer (BC) at the time of transurethral resection (TUR). NBI cystoscopy could increase the detection of BC, but it remains unclear whether narrow band imaging-assisted transurethral resection (NBI-TUR) could reduce the recurrence risk of non-muscle invasive bladder cancer (NMIBC). Several randomized clinical trials (RCTs) have recently tested the efficacy of NBI-TUR for NMIBC.ObjectiveTo perform a systematic review and meta-analysis of RCTs and evaluate the efficacy of NBI-TUR for NMIBC compared with white light imaging-assisted transurethral resection (WLI-TUR). The end point was recurrence risk.Evidence acquisition: A systematic review of PubMed, Medline, Ovid, Embase, Cochrane and Web of Science was performed in February 2016 and updated in July 2016.Evidence synthesis: Overall, six (n = 1084) of 278 trials were included. Three trials performed narrow band imaging-assisted electro-transurethral resection (NBI-ETUR), and two trials performed narrow band imaging-associated bipolar plasma vaporization (NBI-BPV). The last trial performed narrow band imaging-associated holmium laser resection (NBI-HLR). Statistical analysis was performed using Review Manager software (RevMan v.5.3; The Nordic Cochrane Center, Copenhagen, Denmark). The recurrence risk was compared by calculating risk ratios (RRs) with 95% confidence interval (CIs). Risk ratios with 95% CIs were calculated to compare 3-mo, 1-yr, and 2-yr survival rates. NBI-TUR was associated with improvements in the 3-mo recurrence risk (RR: 0.39; 95% CI, 0.26-0.60; p < 0.0001), 1-yr recurrence risk (RR: 0.52; 95% CI, 0.40-0.67; p < 0.00001) and 2-yr recurrence risk (RR: 0.60; 95% CI, 0.42-0.85; p = 0.004) compared with WLI-TUR.ConclusionsCompared with WLI-TUR, NBI-TUR can reduce the recurrence risk of NMIBC. The results of this review will facilitate the appropriate application of NBI in NMIBC.
Highlights
Bladder cancer (BC) is a heterogeneous disease and the fourth most common malignant tumor, after prostate cancer, lung cancer, and colon cancer, in Western countries [1]
narrow band imaging (NBI)-transurethral resection (TUR) was associated with improvements in the 3-mo recurrence risk (RR: 0.39; 95% confidence interval (CI), 0.26-0.60; p < 0.0001), 1-yr recurrence risk (RR: 0.52; 95% CI, 0.40-0.67; p < 0.00001) and 2-yr recurrence risk (RR: 0.60; 95% CI, 0.42-0.85; p = 0.004) compared with white light imaging (WLI)-TUR
The results of this review will facilitate the appropriate application of NBI in non-muscle invasive bladder cancer (NMIBC)
Summary
Bladder cancer (BC) is a heterogeneous disease and the fourth most common malignant tumor, after prostate cancer, lung cancer, and colon cancer, in Western countries [1]. The incidence of BC is three to four times higher in men than in women. Most newly diagnosed BCs are non-invasive urothelial tumors that are confined to the mucosa or mucosal lamina propria [3]. It is a long-term process from a predisposing change to relapse [4]. It is a major challenge to reduce the high frequency of early recurrence risk of non-muscle invasive bladder cancer (NMIBC) because of the high recurrence rate, which can be as high as 45% at the first follow-up cystoscopy, 3 mo after TUR [6]. Neglected lesions will significantly affect the patient’s management and outcome [8]
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