Effects of fluorescent light-guided transurethral resection on non-muscle-invasive bladder cancer: a systematic review and meta-analysis
Effects of fluorescent light-guided transurethral resection on non-muscle-invasive bladder cancer: a systematic review and meta-analysis
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DOI：
10.1111/j.1464-410x.2011.10892.x
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发表时间：
2012-09-01
影响因子：
4.5
通讯作者：
Wang, Jia
中科院分区：
文献类型：
--
作者：
Shen, Pengfei;Yang, Jie;Wang, Jia
关于这个问题有什么进展？这项研究增加了什么？FL引导下TURBT可以降低NMIBC的残留率，但我们的系统评价表明，它在诊断准确性方面并不上级传统WL引导的TURBT，并且对短期RFS和PFS没有显著影响。目的评估荧光（FL）引导下经尿道切除术（TUR）对非肌层浸润性膀胱癌（NMIBC）的诊断准确性和治疗效果。方法检索PUBMED、EMBASE和科克伦图书馆中比较FL和WL引导下膀胱肿瘤经尿道电切术（TURBT）疗效的随机对照试验，包括肿瘤检出率、假阳性率、原位癌（CIS）检出率、肿瘤残留率、无复发生存期（RFS）和无进展生存期（PFS）。使用REVMAN5.1软件进行荟萃分析。来自14项研究的数据，涉及4078例疑似或确诊的NMIBC患者，合并并纳入荟萃分析。肿瘤检出率无显著差异（相对危险度[RR] 0.99; 95%置信区间[CI] 0.96 - 1.03; P = 0.64）和CIS检出率FL组与WL组间的RR值为0.82，95%CI为0.67 ~ 1.02，P = 0.07，FL组的假阳性率高于WL组（RR 0.69，95%CI 0.49 ~ 0.97，P = 0.03），WL组肿瘤残留率高于FL组（RR 2.77; 95%CI 1.47 - 5.02; P = 0.002），随访3个月时两组间差异无统计学意义（RR 1.15; 95% CI 0.79 - 1.66; P = 0.46）或12个月随访（RR 0.86; 95% CI 0.70 - 1.06; P = 0.16）或12个月时的RFS或PFS（RR 0.99; 95% CI 0.94 - 1.04; P = 0.57）和24个月随访（RR 1.02; 95% CI 0.98 - 1.06; P = 0.35）。虽然FL引导下TURBT在降低肿瘤残留率方面具有优势，但对短期RFS和PFS无显著影响。
What's known on the subject? and What does the study add?It was well known that FL-guided TURBT could reduce the residual rate of NMIBC, but our systematic review suggested that it was not superior to conventional WL-guided TURBT in diagnostic accuracy and it had no significant effect on short-term RFS and PFS.OBJECTIVETo assess the diagnostic accuracy and therapeutic outcomes of fl uorescent light (FL)-guided transurethral resection (TUR) in non-muscle-invasive bladder cancer (NMIBC).METHODSA systematic search of PUBMED, EMBASE and Cochrane Library was performed to identify randomized controlled trials comparing the outcomes of FL-and white-light (WL)-guided TUR of bladder tumours (TURBT).Outcomes included tumour detection rate, false-positive diagnosis rate, carcinoma in situ (CIS) detection rate, residual tumour rate, recurrence-free survival (RFS) and progression-free survival (PFS).REVMAN 5.1 software was used for the meta-analysis.RESULTSData from 14 studies, involving 4078 patients with suspected or proven NMIBC, were pooled and included in the meta-analysis.There was no signifi cant difference in tumour detection rate (relative risk [RR] 0.99; 95% confi dence interval [CI] 0.96 -1.03; P = 0.64) and CIS detection rate (RR 0.82; 95% CI 0.67 -1.02; P = 0.07) between the FL and the WL groups.The false-positive diagnosis rate of the FL group was higher than that of the WL group (RR 0.69; 95% CI 0.49 -0.97; P = 0.03).The tumour residual rate was higher in the WL group than in the FL group (RR 2.77; 95% CI 1.47 -5.02; P = 0.002).No significant differences were found between groups at 3-month follow-up (RR 1.15; 95% CI 0.79 -1.66; P = 0.46) or 12-month follow-up (RR 0.86; 95% CI 0.70 -1.06; P = 0.16) or in terms of either RFS or PFS at 12-month (RR 0.99; 95% CI 0.94 -1.04; P = 0.57) and 24-month follow-up (RR 1.02; 95% CI 0.98 -1.06; P = 0.35).CONCLUSIONFL-guided TURBT was not superior to conventional WL in diagnostic accuracy. Although FL-guided TURBT had an advantage in reducing the residual tumour rate, it had no signifi cant effect on short-term RFS and PFS.