AUA 2018: The Impact of Blue-Light Cystoscopy on Response to Induction BCG in Patients with High-Grade Non-Muscle Invasive Bladder Cancer

San Francisco, CA USA ( Recent randomized clinical trials have demonstrated the superiority of blue light cystoscopy (BLC) during transurethral resection of bladder tumor (TURBT) over regular white light cystoscopy in regard to early recurrence rates. This improvement is likely related to the resection of smaller lesions which are often missed in white light cystoscopy. Animal studies have shown that BCG effectiveness is improved by the presence of bladder cancer tumor cells in the bladder. To date, the effect of improved tumor clearance associated with BLC on BCG effectiveness remains unstudied. Nina Mikkilineni, MD, from Columbia University, presents a retrospective study to investigate the effect of BLC TURBT on BCG effectiveness in patients with high risk non-muscle invasive bladder cancer (NMIBC).

The study retrospectively reviewed 148 patients with high-grade NMIBC at our institution who received induction BCG from 2014 to 2016. Of the 148 patients, 103 patients had 3-month follow up with a cystoscopic evaluation following completion of induction BCG. Disease recurrence was defined as a visible or biopsy-proven tumor or positive urine cytology at 3 months. Multivariate logistic regression analyses were performed to examine the association between type of cystoscopy (blue light vs. white light) and 3-month recurrence rate. Model covariates included stage, history of NMIBC, and prior intravesical therapy.

33 patients underwent BLC cystoscopy prior to BCG induction over the study period. Patients in the BLC group were more likely to have carcinoma in situ (67% vs. 47%, p=0.10), prior NMIBC (42% vs. 30%, p=0.31), and prior intravesical therapy (36% vs. 11%, p=0.007). At 3-month cystoscopy, 13 patients (39%) in the BLC group and 24 (34%) in the WLC group experienced a recurrence (p=0.78). On multivariate analysis, BLC did not have significant effect on bladder cancer recurrence (OR = 1.11, [95% CI 0.42, 2.93]; p=0.83).

In summary, the use of a BLC TURBT did not have a significant effect on the risk of 3-month recurrence in patients with high-risk NIMBC treated with induction BCG. While the hypothesis for the study was thought provoking the study was not powered or designed to answer the study hypothesis. Surrogates of BCG effectiveness such as cytokine levels should have been used instead to clinical end-points. Moreover, the findings presented by the authors are in contradiction with recent level one evidence demonstrating a clear benefit of BLC in the reduction of early recurrences in patients with NIMBC. The reason for the contradictory results may lie in the definition used for recurrence which includes the finding of CIS or positive cytology on 3-month follow-up.

Presented by: Nina Mikkilineni, MD (Department of Urology, Columbia University NY, NY)

Written by: Andres F. Correa, MD, Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA, at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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