Randomized Comparison Between Photodynamic Diagnosis and White Light-Guided TURBT in Patients with Non-Muscle Invasive Bladder Cancer - Expert Commentary

After transurethral bladder tumor resection (TURBT), recurrence of non-muscle-invasive bladder cancer (NMIBC) is common. Recently, Heer at al. performed an open-label, parallel-group randomized trial conducted in 22 National Health Service hospitals in the United Kingdom.

The investigators recruited participants with a suspected first diagnosis of NMIBC at intermediate or high risk for recurrence based on routine visual assessment prior to TURBT. Participants were randomly assigned to TURBT guided by photodynamic diagnosis (PDD) or white light (WL). 538 participants were enrolled (269 in each group), and 112 were excluded due to a lack of histologic confirmation of NMIBC or prior cystectomy.

After a median follow-up of 44 months, 86 of 209 patients in the PDD group and 84 of 217 patients in the WL group had recurrences. The recurrence hazard ratio was 0.94 (95% confidence interval [CI]: 0.69 to 1.28; P=0.70). Three-year recurrence-free rates were 57.8% (95% CI, 50.7 to 64.2) and 61.6% (95% CI, 54.7 to 67.8) in the PDD and WL groups. There was a modest absolute risk reduction (3.8 percentage points: 95% confidence interval [CI], −13.4 to 6.6) of tumor recurrence. The rates of adverse events were comparable between groups, as was health-related quality of life. PDD-guided TURBT is more expensive than WL-guided TURBT, with no evidence of a difference in quality-adjusted life years (0.007; 95% CI, 0.133 to 0.119; P=0.444).

Previous studies showed higher sensitivity for the detection of NMIBC and better clinical outcomes with PDD. However, this important randomized trial shows no advantages for PDD-guided TURBT in terms of clinical outcomes or cost savings.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References:

  1. Heer R., Lewis R., Vadiveloo T. et al. A Randomized Trial of PHOTOdynamic Surgery in Non–Muscle-Invasive Bladder Cancer. NEJM Evid 2022; 1 (10) DOI: https://doi.org/10.1056/EVIDoa2200092
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