ASCO GU 2023: The Impact of Blue Light Cystoscopy Use Among Patients with Non-Muscle Invasive Bladder Cancer In An Equal Access Setting

( In this abstract by Sanjay Das and colleagues, they evaluate the impact of Blue Light Cystoscopy (BLC) use among patients with non-muscle invasive bladder cancer (NMIBC) in an equal access setting, specifically the Veterans Affairs (VA) system. Per the authors, prior studies suggest that white light cystoscopy (WLC) alone can fail to detect cases of NMIBC compared to BLC. BLC reportedly can reduce recurrence rates relative to WLC alone. The investigators chose to describe bladder cancer outcomes and the impact of BLC among NMIBC patients in an equal access setting.

They utilized inpatient data, outpatient data, and fee-based claims (care outside the VA which the VA paid for) to query for patients with bladder cancer who underwent BLC between 12/1/2014 to 12/31/2020 (~6 years). A total of 378 NMIBC patients within the Veterans Affairs system that had a CPT code for BLC were assessed. They determined recurrence rates and time to recurrence prior to BLC (i.e. after previous WLC if available) and following BLC. They used the Kaplan-Meier method to estimate event-free survival and Cox regression to determine the association between race and recurrence, progression, and overall survival (OS).

Table 1 below summarized the details of the cohort:

Blue Light Cystoscopy (BLC).jpg

In general, 43 (11%) were Black and 300 (79%) White. Median follow-up was 40.7 months from bladder cancer diagnosis. There were 194 (51%) patients with either TaHG or T1 without CIS; 52 (14%) had CIS with or without TaHG or T1; and 127 (34%) had TaLG only. A total of 239 (63%) patients received BCG at any point during the study.

Looking at recurrence rates:

ASCO GU Blue Light Cystoscopy (BLC).jpg

Median time to first recurrence following BLC was longer compared to WLC alone (40 (33-NE) vs. 26 (17-39) months).

When comparing WLC vs BLC rates of recurrence:

ASCO GU 23 Blue Light Cystoscopy (BLC).jpg

The risk of recurrence was significantly lower following BLC (Hazard Ratio (HR) 0.70; 95% Confidence Interval (CI) 0.54-0.90). There was no significant difference in recurrence (Hazard Ratio (HR) 0.83; 95% Confidence Interval (CI) 0.48-1.43), progression (HR 1.46; 95% CI 0.45-4.74), and overall survival (HR 0.69; 95% CI 0.29-1.65) following BLC by Black vs. White race.

The KM curve for the recurrence is seen below.

Blue Light Cystoscopy (BLC) ASCO GU.jpg

So, as the authors note, in this study from an equal access setting in the VA, they observed significantly decreased risk of recurrence and prolonged time interval to recurrence following BLC compared to WLC alone – BUT, there was no difference in any bladder cancer OS nor any outcomes by race.

Presented by: Sanjay Das, MD, UCLA Health, Department of Urology, Los Angeles, CA

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Associate Professor of Urology, University of California, Davis @tchandra_uromd on Twitter during the 2023 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, Thurs, Feb 16 – Sat, Feb 18, 2023.