AI Article Synopsis
- The study aimed to determine the prognostic value of photodynamic diagnosis (PDD)-guided bladder tumor resection (TUR-BT) in patients undergoing radical cystectomy (RC) for bladder cancer.
- Out of 224 patients, those who underwent HAL-guided TUR-BT exhibited significantly better 3-year recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) rates compared to those who had ALA or white light (WL) TUR-BT.
- The findings suggest that HAL-guided TUR-BT not only improves patient outcomes but also highlights several independent predictors of survival, emphasizing its potential role in bladder cancer treatment protocols.
Article Abstract
Purpose: To investigate whether photodynamic diagnosis (PDD)-guided bladder tumour resection (TUR-BT) is of prognostic value in patients undergoing subsequent radical cystectomy (RC) for bladder cancer (BC).
Methods: In 224 consecutive patients who underwent RC and bilateral pelvic lymphadenectomy for BC between 2002 and 2010 (median follow-up 29 months [IQR 8-59]), we retrospectively investigated whether patients had previously undergone PDD-guided (hexaminolevulinate [HAL] vs. 5-aminolevulinate [ALA]) versus white light (WL)-TUR-BT. Kaplan-Meier analysis was used to estimate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) using log-rank and Cox regression model for uni- and multivariable analysis.
Results: Of the 224 patients, 66 (29.5 %) underwent HAL-, 23 (10.3 %) ALA- and 135 (60.2 %) WL-TUR-BT before RC. The 3-year RFS/CSS/OS was 77.8/83.9/74.0 % for HAL-, 53.6/74.5/60.9 % for ALA- and 52.4/59.7/56.5 % for WL-TUR-BT (p = 0.002/0.023/0.037 for HAL vs. WL/ALA). PDD-TUR-BT was associated with a higher number of TUR-BTs before RC (p < 0.001) and re-resections (p = 0.015), a longer time between the first TUR-BT and RC (p = 0.044) and a lower rate of post-operative systemic chemotherapy (p = 0.001). In multivariable analysis, performance of HAL-TUR-BT, pathologic tumour and nodal stage as well as soft tissue surgical margin status were independent predictors for RFS, CSS and OS.
Conclusions: This series indicates for the first time that HAL-guided TUR-BT is an independent predictor for improved survival after RC.
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| http://dx.doi.org/10.1007/s00345-015-1485-8 | DOI Listing |
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