Abstract
Clinical evidence regarding risk reduction of repeated bladder recurrence after initial photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) is still limited in patients with non-muscle-invasive bladder cancer (NMIBC). We analyzed patients with primary NMIBC undergoing TURBT without any adjuvant treatment to compare the risk of cumulative recurrence between the conventional white-light (WL)-TURBT and PDD-TURBT. Out of 430 patients diagnosed with primary NMIBC from 2010 to 2019, 40 undergoing WL-TURBT and 60 undergoing PDD-TURBT were eligible. Multivariate Cox regression analysis for time to the first recurrence demonstrated that PDD assistance was an independent prognostic factor with better outcome (p = 0.038, hazard ratio = 0.39, and 95% confidence interval 0.16–0.95). While no patient experienced more than one recurrence within 1000 postoperative days in the PDD-TURBT group, five out of 40 patients treated by WL-TURBT experienced repeated recurrence. The comparison of cumulative incidence per 10,000 person-days between the two groups revealed that PDD assistance decreased by 6.6 recurrences per 10,000 person-days (exact p = 0.011; incidence rate ratio 0.37, Clopper–Pearson confidence interval 0.15–0.82). This is the first study addressing PDD assistance-induced risk reduction of repeated bladder recurrence using the person-time method. Our findings could support clinical decision making, especially on adjuvant therapy after TURBT.
Highlights
Transurethral resection of bladder tumor (TURBT) is the mainstay of treatment and diagnosis in bladder cancer, especially in non-muscle-invasive bladder cancer (NMIBC), accounting for about 80% of bladder cancers [1]. the bladder can be preserved in most patients with NMIBC, frequent and repeated intravesical recurrence after transurethral resection of bladder tumor (TURBT) remains the biggest clinical problem
Over the last couple of decades, 5-aminolevulinic acid (5-ALA) or hexaminolevulinate-induced fluorescence cystoscopy has been developed with the aim of detecting tiny and/or flat lesions [4,5]
The main purpose of this study was to evaluate the real benefit of photodynamic diagnosis (PDD)-TURBT through the sensitive tumor detection and subsequent complete tumor resection
Summary
Transurethral resection of bladder tumor (TURBT) is the mainstay of treatment and diagnosis in bladder cancer, especially in non-muscle-invasive bladder cancer (NMIBC), accounting for about 80% of bladder cancers [1]. the bladder can be preserved in most patients with NMIBC, frequent and repeated intravesical recurrence after TURBT remains the biggest clinical problem. Transurethral resection of bladder tumor (TURBT) is the mainstay of treatment and diagnosis in bladder cancer, especially in non-muscle-invasive bladder cancer (NMIBC), accounting for about 80% of bladder cancers [1]. 500–1000 days, and another small peak around 1500 days [2] When the former two peaks are defined by ‘early recurrence,’ it is considered that the early recurrence is largely attributed to tiny or flat lesions, which are overlooked by conventional white-light (WL)- TURBT [2,3]. Improving the quality of TURBT and increasing the rate of complete tumor resection is essential to reduce the risk of recurrence. The clear benefit of photodynamic diagnosis (PDD)-assisted TURBT using 5-ALA in terms of improved tumor detection rate and better oncological outcome has been confirmed in Japan [6–8]. Oral 5-ALA was approved as an intraoperative diagnostic drug in Japan in December 2017, and its use has been strongly recommended in the Japanese
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