Narrow band imaging versus white light cystoscopy alone for transurethral resection of non-muscle invasive bladder cancer.

Abstract

Disease recurrence and progression remain major challenges for the treatment of non-muscle invasive bladder cancer. Narrow band imaging (NBI) is an opticalenhancement technique that may improveresection of non-muscle invasive bladder cancer and thereby lead to better outcomes for people undergoing the procedure. OBJECTIVES: To assess the effects of NBI- and white light cystoscopy (WLC)-guided transurethral resection of bladder tumor (TURBT) compared to WLC-guided TURBT in the treatment of non-muscle invasive bladder cancer. We performed a comprehensive literaturesearch of 10 databases, including the Cochrane Library, theCochrane Database of Systematic Reviews, MEDLINE, Embase, several clinical trial registries, and grey literaturefor published and unpublished studies, irrespective of language. The search was performed per an a priori protocol on 3 December 2021. We included randomized controlled trials of participants with suspected or confirmed non-muscle invasive bladder cancer. Participants in the control group must have receivedWLC-guided TURBT alone (hereinafter simply referred to as 'WLC TURBT'). Participantsin the intervention group had to have received NBI- and WLC-guided TURBT (hereinafter simply referred to as 'NBI + WLC TURBT'). Two review authors independently selected studies for inclusion/exclusion, performed data extraction, and assessed risk of bias. We conducted meta-analysis ontime-to-event and dichotomous data using a random-effects model in RevMan, according to Cochrane methods.We rated the certainty of evidence for each outcome according to the GRADE approach. Primary outcomes were time to recurrence, time to progression, and the occurrence of a major adverse event, defined as a Clavien-Dindo III, IV, or V complication. Secondary outcomes included time to death from bladder cancer and the occurrence of a minor adverse event, defined as a Clavien-Dindo I or II complication. MAIN RESULTS: We included eight studies witha total of 2152 participants randomized tothe standardWLC TURBT or to NBI + WLC TURBT. A total of 1847 participants were included for analysis. Based on limited confidence in the time-to-event data, we found that participants who underwent NBI + WLC TURBT had a lower risk of disease recurrence over time compared to participants who underwent WLC TURBT (hazard ratio 0.63, 95% CI 0.45 to 0.89; I2 = 53%; 6 studies,1244 participants; low certainty of evidence). No studies examined disease progression as a time-to-event outcomeor a dichotomous outcome. There was likely no difference in the risk of a major adverse event between participants who underwent NBI + WLC TURBT and those who underwent WLC TURBT (risk ratio1.77, 95% CI0.79 to 3.96; 4studies, 1385 participants; low certainty of evidence). No studies examined death from bladder cancer as a time-to-event outcomeor a dichotomous outcome. There was likely no difference in the risk of a minor adverse event between participants who underwent NBI + WLC TURBT and those who underwent WLC TURBT (risk ratio 0.88, 95% CI0.49to 1.56; I2 = 61%; 4studies, 1385 participants;low certainty of evidence). AUTHORS' CONCLUSIONS: Compared to WLC TURBT alone, NBI + WLC TURBT may lower the risk of disease recurrence over time whilehaving little or no effect on the risks of major or minor adverse events.