Differences in oncological benefits from second transurethral resection between white-light initial surgery and photodynamic diagnosis-guided initial surgery for primary high-risk non-muscle invasive bladder cancer.

Publisher: Blackwell Science Asia Country of Publication: Australia NLM ID: 9440237 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1442-2042 (Electronic) Linking ISSN: 09198172 NLM ISO Abbreviation: Int J Urol Subsets: MEDLINE

Publication: Carlton South, Vic. : Blackwell Science Asia
Original Publication: Tokyo ; New York : Churchill Livingstone, c1994-

Cystectomy*/methods ; Neoplasm Recurrence, Local*/epidemiology ; Neoplasm Recurrence, Local*/prevention & control ; Non-Muscle Invasive Bladder Neoplasms*/mortality ; Non-Muscle Invasive Bladder Neoplasms*/pathology ; Non-Muscle Invasive Bladder Neoplasms*/surgery; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Disease Progression ; Neoplasm Invasiveness ; Neoplasm, Residual ; Progression-Free Survival ; Propensity Score ; Reoperation/statistics & numerical data ; Retrospective Studies ; Urinary Bladder/pathology ; Urinary Bladder/surgery

Objectives: The aim of this study was to compare clinical outcomes between patients receiving second TUR after initial white-light transurethral resection of bladder tumor (WL-TURBT) and initial photodynamic diagnosis (PDD)-assisted TURBT.
Methods: A total of 1007 patients were divided into four groups based on the treatment pattern: WL-TURBT with second TUR (161 patients, WL-second group) or without second TUR (540 patients, WL-alone group) and PDD-TURBT with second TUR (112 patients, PDD-second group) or without second TUR (194 patients, PDD-alone group). Oncologic outcomes (bladder cancer recurrence, progression, urothelial cancer-specific mortality) and rates of residual tumor and risk stratification of non-muscle-invasive bladder cancer (NMIBC) after second TUR were evaluated.
Results: After propensity score-matching 121 patients were included each in the WL-alone and WL-second groups, and 63 patients each in the PDD-alone and PDD-second groups. In the WL group, the second TUR was significantly associated with improved progression-free (p = 0.012) and urothelial cancer-specific free survival (p = 0.011), but not with recurrence-free survival (p = 0.93). Patients initially treated with PDD-TURBT, and with a tumor diameter <30 mm and multifocality had a relatively high benefit from second TUR. The rates of residual tumor and risk stratification of NMIBC did not significantly differ between WL-TURBT and PDD-TURBT groups.
Conclusions: Our findings suggested that a second TUR could be omitted after an initial PDD-TURBT in selected patients with high-risk NMIBC.
(© 2024 The Japanese Urological Association.)

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16K20159 Japan Society for the Promotion of Science; 26861290 Japan Society for the Promotion of Science; 23K08720 Japan Society for the Promotion of Science

Keywords: aminolevulinic acid; disease progression; local; neoplasm recurrence; photodynamic diagnosis; urinary bladder neoplasms

Date Created: 20240430 Date Completed: 20240801 Latest Revision: 20240826

20240826

10.1111/iju.15474

38687165