Photodynamic Diagnosis of Non–muscle-invasive Bladder Cancer with Hexaminolevulinate Cystoscopy: A Meta-analysis of Detection and Recurrence Based on Raw Data

Abstract Background Studies on hexaminolevulinate (HAL) cystoscopy report improved detection of bladder tumours. However, recent meta-analyses report conflicting effects on recurrence. Objective To assess available clinical data for blue light (BL) HAL cystoscopy on the detection of Ta/T1 and carcin...

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Bibliographic Details
Published in:European urology 2013-11, Vol.64 (5), p.846-854
Main Authors: Burger, Maximilian, Grossman, H. Barton, Droller, Michael, Schmidbauer, Joerg, Hermann, Gregers, Drăgoescu, Octavian, Ray, Eleanor, Fradet, Yves, Karl, Alexander, Burgués, Juan Pablo, Witjes, J. Alfred, Stenzl, Arnulf, Jichlinski, Patrice, Jocham, Dieter
Format: Article
Language:English
Subjects:
Aminolevulinic Acid - analogs & derivatives
Biological and medical sciences
Bladder cancer
Carcinoma in Situ - mortality
Carcinoma in Situ - pathology
Carcinoma in Situ - therapy
Cystoscopy - methods
HAL blue light cystoscopy
Hexaminolevulinate
Humans
Kaplan-Meier Estimate
Medical sciences
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Nephrology. Urinary tract diseases
Predictive Value of Tests
Risk Factors
Time Factors
Treatment Outcome
Tumors
Tumors of the urinary system
Urinary Bladder - pathology
Urinary Bladder Neoplasms - mortality
Urinary Bladder Neoplasms - pathology
Urinary Bladder Neoplasms - therapy
Urinary tract. Prostate gland
Urology
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Summary:Abstract Background Studies on hexaminolevulinate (HAL) cystoscopy report improved detection of bladder tumours. However, recent meta-analyses report conflicting effects on recurrence. Objective To assess available clinical data for blue light (BL) HAL cystoscopy on the detection of Ta/T1 and carcinoma in situ (CIS) tumours, and on tumour recurrence. Design, setting, and participants This meta-analysis reviewed raw data from prospective studies on 1345 patients with known or suspected non–muscle-invasive bladder cancer (NMIBC). Intervention A single application of HAL cystoscopy was used as an adjunct to white light (WL) cystoscopy. Outcome measurements and statistical analysis We studied the detection of NMIBC (intention to treat [ITT]: n = 831; six studies) and recurrence (per protocol: n = 634; three studies) up to 1 yr. DerSimonian and Laird's random-effects model was used to obtain pooled relative risks (RRs) and associated 95% confidence intervals (CIs) for outcomes for detection. Results and limitations BL cystoscopy detected significantly more Ta tumours (14.7%; p < 0.001; odds ratio [OR]: 4.898; 95% CI, 1.937–12.390) and CIS lesions (40.8%; p < 0.001; OR: 12.372; 95% CI, 6.343–24.133) than WL. There were 24.9% patients with at least one additional Ta/T1 tumour seen with BL ( p < 0.001), significant also in patients with primary (20.7%; p < 0.001) and recurrent cancer (27.7%; p < 0.001), and in patients at high risk (27.0%; p < 0.001) and intermediate risk (35.7%; p = 0.004). In 26.7% of patients, CIS was detected only by BL ( p < 0.001) and was also significant in patients with primary (28.0%; p < 0.001) and recurrent cancer (25.0%; p < 0.001). Recurrence rates up to 12 mo were significantly lower overall with BL, 34.5% versus 45.4% ( p = 0.006; RR: 0.761 [0.627–0.924]), and lower in patients with T1 or CIS ( p = 0.052; RR: 0.696 [0.482–1.003]), Ta ( p = 0.040; RR: 0.804 [0.653–0.991]), and in high-risk ( p = 0.050) and low-risk ( p = 0.029) subgroups. Some subgroups had too few patients to allow statistically meaningful analysis. Heterogeneity was minimised by the statistical analysis method used. Conclusions This meta-analysis confirms that HAL BL cystoscopy significantly improves the detection of bladder tumours leading to a reduction of recurrence at 9–12 mo. The benefit is independent of the level of risk and is evident in patients with Ta, T1, CIS, primary, and recurrent cancer.
ISSN:0302-2838
1873-7560
DOI:10.1016/j.eururo.2013.03.059