1293 A META-ANALYSIS OF BLUE LIGHT CYSTOSCOPY WITH HEXAMINOLEVULINATE IN PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER
2013-03-27

You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 20131293 A META-ANALYSIS OF BLUE LIGHT CYSTOSCOPY WITH HEXAMINOLEVULINATE IN PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER Leonard Gomella, H. Barton Grossman, Michael Droller, Jorg Schmidbauer, Gregers Hermann, Octavian Dragoescu, Eleanor Ray, Alfred Witjes, Alexander Karl, Arnulf Stenzl, Yves Fradet, Juan Burgues, and Dieter Jocham Leonard GomellaLeonard Gomella Philadelphia, PA , H. Barton GrossmanH. Barton Grossman Houston, TX , Michael DrollerMichael Droller New York, NY , Jorg SchmidbauerJorg Schmidbauer Vienna, Austria , Gregers HermannGregers Hermann Copenhagen, Denmark , Octavian DragoescuOctavian Dragoescu Craiova, Romania , Eleanor RayEleanor Ray London, United Kingdom , Alfred WitjesAlfred Witjes Nijmegen, Netherlands , Alexander KarlAlexander Karl Munich, Germany , Arnulf StenzlArnulf Stenzl tuebingen, Germany , Yves FradetYves Fradet Quebec, Canada , Juan BurguesJuan Burgues Palma de Mallorca, Spain , and Dieter JochamDieter Jocham Lubeck, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2647AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the available clinical data for blue light (BL) cystoscopy with hexaminolevulinate on the detection of papillary (Ta/T1) and flat (CIS) tumors, and on tumor recurrence. METHODS A meta-analysis was conducted on raw patient data from eight prospective studies totalling 1293 patients. Studies included consecutively enrolled patients with known or suspected non-muscle invasive bladder cancer, and used BL cystoscopy with hexaminolevulinate as an adjunct to white light (WL) cystoscopy (equipment from Karl Storz, Germany) in randomized groups or within-patient comparison. Intention-to-treat populations (n=790) were used for detection analysis and Per Protocol for recurrence (n=634). Analysis was also carried out on sub-groups of patients: initial or recurrent cancer; high, intermediate and low risk; and previous treatment. RESULTS There were 21.3% (168/790) patients in whom at least one additional Ta/T1 tumor was detected only with BL (p<0.001; event rate=0.217 [0.193-0.247]). In initial and recurrent sub-groups, lesions were seen only with BL in 16.8% (58/346) and 24.8% (110/444) of patients, respectively (p<0.001). In patients who had received prior BCG or chemotherapy, lesions were seen only under BL in 25% (48/192) patients (p<0.001). In those patients who had at least one CIS lesion at diagnosis, CIS lesions were seen only with BL in 61/256 (23.8%) patients, while no CIS lesions were seen with white light (p<0.001; ER=0.246 [0.196-0.304]). At lesion level BL cystoscopy detected significantly more Ta tumors (13.2%; p<0.001, OR=2.136 [CI: 1.578–2.890]), than WL cystoscopy. The benefit was particularly significant in high risk (p=0.007) and intermediate risk Ta patients (p<0.001) and in T1 patients with initial cancer (11.2%; p=0.003, OR=3.978 [CI: 1.617–9.785]). There was also a significant benefit in patients who had received prior BCG or chemotherapy (p<0.001). Recurrence rates measured at 9–12 months were significantly lower overall with BL: 34.5% BL vs 45.4% WL (p=0.006, risk ratio=0.781). Risk ratios for recurrence were also lower in the sub-groups of patients with T1 or CIS (p=0.052, RR=0.696), and those with Ta (p=0.004, RR=0.804). CONCLUSIONS This meta-analysis confirmed that BL cystoscopy with hexaminolevulinate added to WL cystoscopy significantly assists the detection of bladder tumors at both a patient and tumor level. The benefit of improved detection with BL cystoscopy led to improved clinical outcomes by reducing recurrence rates at 9–12 months. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e528 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonard Gomella Philadelphia, PA More articles by this author H. Barton Grossman Houston, TX More articles by this author Michael Droller New York, NY More articles by this author Jorg Schmidbauer Vienna, Austria More articles by this author Gregers Hermann Copenhagen, Denmark More articles by this author Octavian Dragoescu Craiova, Romania More articles by this author Eleanor Ray London, United Kingdom More articles by this author Alfred Witjes Nijmegen, Netherlands More articles by this author Alexander Karl Munich, Germany More articles by this author Arnulf Stenzl tuebingen, Germany More articles by this author Yves Fradet Quebec, Canada More articles by this author Juan Burgues Palma de Mallorca, Spain More articles by this author Dieter Jocham Lubeck, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...