Impact of enhanced optical techniques at time of transurethral resection of bladder tumour, with or without single immediate intravesical chemotherapy, on recurrence rate of non-muscle-invasive bladder cancer: a systematic review and network meta-analysis of randomized trials

原文： 2021 年发布于 Arab Journal of Urology 10 卷第 2 期 204-214  浏览量：298次

作者： Sari Motlagh R. Mori K. Laukhtina E. Aydh A. Katayama S. Grossmann N. C. Mostafai H. Pradere B. Quhal F. Schuettfort V. M. Roshandel M. R. Karakiewicz P. I. Teoh J. Shariat S. F. Fajkovic H.

作者单位： Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. Department of Urology, Weill Cornell Medical College, New York, New York. Department of Urology, University of Texas Southwestern, Dallas, Texas. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. Department of Urology, University of Jordan, Amman, Jordan. European Association of Urology Research Foundation, Arnhem, Netherlands.

归属分类：膀胱肿瘤治疗及预后证据

DOI： 10.1002/14651858.CD009294.pub3

关键词： Biomarkers Carcinogens/analysis *Electronic Nicotine Delivery Systems Humans *Urinary Bladder Neoplasms/diagnosis/epidemiology/etiology *Vaping Bladder cancer Carcinogens Electronic cigarette Urinary biomarkers

Objective To assess whether single immediate intravesical chemotherapy (SIIC) adds value to bladder tumour management in combination with novel optical techniques: enhanced transurethral resection of bladder tumour (TURBT). Methods A systematic search was performed using the PubMed and Web of Science databases in September 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) extension statement for network meta-analyses. Studies that compared recurrence rates among intervention groups (TURBT with photodynamic diagnosis [PDD] +/- SIIC, narrow-band imaging [NBI] +/- SIIC, or white-light cystoscopy [WLC] + SIIC) and a control group (TURBT with WLC alone) were included. We used the Bayesian approach in the network meta-analysis. Results Twenty-two studies (n = 4519) met our eligibility criteria. Out of six different interventions including three different optical techniques, compared to WLC alone, blue-light cystoscopy (BLC) plus SIIC (odds ratio [OR] 0.349, 95% credible interval [CrI] 0.196-0.601) and BLC alone (OR 0.668, 95% CrI 0.459-0.931) were associated with a significantly lower likelihood of 12-month recurrence rate. In the sensitivity analysis, out of eight different interventions compared to WLC alone, PDD by 5-aminolevulinic acid plus SIIC (OR 0.327, 95% CrI 0.159-0.646) and by hexaminolevulinic acid plus SIIC (OR 0.376, 95% CrI 0.172-0.783) were both associated with a significantly lower likelihood of 12-month recurrence rate. NBI with and without SIIC was not associated with a significantly lower likelihood of 12-month recurrence rate (OR 0.385, 95% CrI 0.105-1.29 and OR 0.653, 95% CrI 0.343-1.15). Conclusion Blue-light cystoscopy during TURBT with concomitant SIIC seems to yield superior recurrence outcomes in patients with non-muscle-invasive bladder cancer. The use of PDD was able to reduce the 12-month recurrence rate; moreover, concomitant SIIC increased this risk benefit by a 32% additional reduction in odds ratio. Although using PDD could reduce the recurrence rate, SIIC remains necessary. Moreover, ranking analysis showed that both PDD and NBI, plus SIIC, were better than these techniques alone.