Photodynamic Diagnosis of Non-muscle-invasive Bladder Cancer with Hexaminolevulinate Cystoscopy: A Meta-analysis of Detection and Recurrence Based on Raw Data
Photodynamic Diagnosis of Non-muscle-invasive Bladder Cancer with Hexaminolevulinate Cystoscopy: A Meta-analysis of Detection and Recurrence Based on Raw Data
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DOI：
10.1016/j.eururo.2013.03.059
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发表时间：
2013-11-01
期刊：
影响因子：
23.4
通讯作者：
Jocham, Dieter
中科院分区：
文献类型：
--
作者：
Burger, Maximilian;Grossman, H. Barton;Jocham, Dieter
背景：六氨基乙酰丙酸 (HAL) 膀胱镜检查的研究报告改善了膀胱肿瘤的检测。然而，最近的荟萃分析报告了对复发的相互矛盾的影响。目的：评估蓝光 (BL) HAL 膀胱镜检查在检测 Ta/T1 和原位癌 (CIS) 肿瘤以及肿瘤复发方面的可用临床数据。设计、设置和参与者：这项荟萃分析回顾了对 1345 名已知或疑似非肌层浸润性膀胱患者进行前瞻性研究的原始数据 干预：单次应用 HAL 膀胱镜检查作为白光 (WL) 膀胱镜检查的辅助手段。结果测量和统计分析：我们研究了长达 1 年的 NMIBC 检测（意向治疗 [ITT]：n = 831；六项研究）和复发（根据方案：n = 634；三项研究）。 DerSimonian 和 Laird 的随机效应模型用于获得检测结果的汇总相对风险 (RR) 和相关的 95% 置信区间 (CI)。结果和局限性：BL 膀胱镜检查检测到明显更多的 Ta 肿瘤（14.7%；p < 0.001；比值比 [OR]：4.898；95% CI，1.937-12.390）和 CIS 病变 (40.8%；p < 0.001；OR：12.372；95% CI，6.343-24.133) 高于 WL。有 24.9% 的患者在 BL 中发现至少一个额外的 Ta/T1 肿瘤 (p < 0.001)，这在原发性癌症 (20.7%; p < 0.001) 和复发性癌症 (27.7%; p < 0.001) 患者以及高风险 (27.0%; p < 0.001) 和中度风险 (35.7%; p = 0.004）。在 26.7% 的患者中，CIS 仅通过 BL 检测到（p < 0.001），并且在原发性癌症（28.0%；p < 0.001）和复发性癌症患者（25.0%；p < 0.001）中也很显着。 BL 组至 12 个月的复发率总体显着较低，分别为 34.5% 与 45.4%（p = 0.006；RR：0.761 [0.627-0.924]），T1 或 CIS 患者的复发率更低（p = 0.052；RR：0.696 [0.482-1.003]）、Ta（p =相对比：0.804； [0.653-0.991]），以及高风险（p = 0.050）和低风险（p = 0.029）亚组。一些亚组的患者太少，无法进行具有统计学意义的分析。通过使用的统计分析方法将异质性降至最低。结论：此荟萃分析证实，HAL BL 膀胱镜检查显着提高了膀胱肿瘤的检出率，从而减少了 9-12 个月的复发。该益处与风险水平无关，并且在 Ta、T1、CIS、原发性和复发性癌症患者中非常明显。 (C) 2013 年欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
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: Thismeta-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. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.