HAL blue-light cystoscopy in high-risk nonmuscle-invasive bladder cancer--re-TURBT recurrence rates in a prospective, randomized study

Abstract

Objectives: To evaluate the impact of hexaminolevulinate blue-light cystoscopy and transurethral resection of bladder tumors (TURBT) upon the short-term recurrence rate in high-risk nonmuscle-invasive bladder cancer (NMIBC) compared with conventional cystoscopy and resection.

Methods: Between December 2007 and November 2009, 446 patients were randomized for blue-light cystoscopy/resection and for standard cystoscopy/resection, respectively. The inclusion criteria consisted of positive urinary cytology and ultrasonographic suspicion of bladder tumors. High-risk NMIBC patients (carcinoma in situ [CIS], pTaG3, and pT1) from both series underwent standard Re-TURBT 6 weeks after the initial procedure.

Results: The proportions of CIS, pTaG3, and pT1 cases in the initial series were 13.1%, 5.7%, and 22.2% in the blue light series and 11.3%, 5.7%, and 23.3% in the white light series. In total, 72 and 64 high-risk cases, respectively, were diagnosed in the blue- and white-light series. The overall short-term recurrence rate at Re-TURBT was 11.1% for the blue-light group and 31.2% for the white-light group. The recurrence rates were 4.3% versus 27.8% for CIS, 10% versus 22.2% for pTaG3, and 15.4% versus 35.1% for pT1 cases, in favor of the blue-light arm. The recurrence rate in patients presenting with high-grade tumors was 17.2% in the blue-light group and 37% in the white-light group.

Conclusions: Blue-light cystoscopy and resection significantly reduced the short-term recurrence rates determined during the standard Re-TURBT in all categories of high-risk patients compared with the standard cystoscopy and resection.