Comparison between intravesical and oral administration of 5-aminolevulinic acid in the clinical benefit of photodynamic diagnosis for nonmuscle invasive bladder cancer
Comparison between intravesical and oral administration of 5-aminolevulinic acid in the clinical benefit of photodynamic diagnosis for nonmuscle invasive bladder cancer
复制标题
DOI：
10.1002/cncr.26378
复制
发表时间：
2012-02-15
期刊：
影响因子：
6.2
通讯作者：
Shuin, Taro
中科院分区：
文献类型：
--
作者：
Inoue, Keiji;Fukuhara, Hideo;Shuin, Taro
背景技术背景：本研究旨在探讨5-氨基乙酰丙酸（ALA）膀胱内及口服光动力学诊断（ALA-PDD）及ALA-PDD引导下经尿道膀胱肿瘤电切术（TURBT）治疗非肌层浸润性膀胱癌的临床价值。方法：210例患者中，75例采用ALA膀胱灌注PDD，135例采用ALA口服PDD。将ALA诱导荧光图像与病理结果进行比较，评价诊断准确性。99例完全可切除病例行PDD-TURBT，对应210例ALA-PDD病例。为了评估PDD-TURBT的能力，回顾性比较了接受传统TURBT的历史对照病例与膀胱内复发的生存分析。结果：ALA-PDD诊断的准确性和能力明显优于传统内镜检查的上级。此外，72.1%的扁平病变，包括不典型增生和原位癌，可以发现只有ALA-PDD。PDD-TURBT的无复发生存率明显高于常规TURBT。此外，多变量分析显示，唯一的独立因素有助于改善预后PDD-TURBT（风险比，0.578; P = 0.012）。无论ALA给药途径如何，在诊断准确性、PDD能力或无复发生存率方面均无显著差异。所有患者对所有手术均耐受良好，无任何严重不良事件。结论：这项多中心研究可能存在偏倚，因为它受到回顾性分析的限制。这项研究表明，无论ALA给药途径如何，ALA-PDD和PDD-TURBT在检测和术中导航程序中都非常有用。Cancer 2012;118：1062-74. (C)2011年美国癌症协会
BACKGROUND: This study was undertaken to evaluate the clinical value of photodynamic diagnosis (PDD) with intravesical and oral instillation of 5-aminolevulinic acid (ALA) (ALA-PDD), and transurethral resection of bladder tumor (TURBT) guided by ALA-PDD (PDD-TURBT) for nonmuscle invasive bladder cancer. METHODS: Of all 210 cases, 75 underwent PDD with intravesically applied ALA, and 135 cases underwent PDD with orally applied ALA. Diagnostic accuracy was evaluated by comparing the level on images of ALA-induced fluorescence with the pathological result. PDD-TURBT was performed in 99 completely resectable cases corresponding to 210 ALA-PDD cases. To evaluate the abilities of PDD-TURBT, survival analysis regarding intravesical recurrence was retrospectively compared with the historical control cases that underwent conventional TURBT. RESULTS: The diagnostic accuracy and capability of ALA-PDD were significantly superior to those of conventional endoscopic examination. Moreover, 72.1% of flat lesions, including dysplasia and carcinoma in situ, could be detected only by ALA-PDD. The recurrence-free survival rate in the cases that underwent PDD-TURBT was significantly higher than that of conventional TURBT. Moreover, multivariate analysis revealed that the only independent factor contributing to improving prognosis was PDD-TURBT (hazard ratio, 0.578; P = .012). Regardless of the ALA administration route, there was no significant difference in diagnostic accuracy, ability of PDD, or recurrence-free survival. All procedures were well tolerated by all patients without any severe adverse events. CONCLUSIONS: This multicenter study is likely to be biased, because it is limited by the retrospective analysis. This study suggests that regardless of the ALA administration route, ALA-PDD and PDD-TURBT are remarkably helpful in detection and intraoperative navigation programs. Cancer 2012;118:1062-74. (C) 2011 American Cancer Society.