Oliva Encina José, Rioja Sanz Carlos
Servicio de Urología, Hospital Royo Villanova, Zaragoza, España.
Actas Urol Esp. 2009 Oct;33(9):965-75. doi: 10.1016/s0210-4806(09)72895-5.
Non-muscle invasive bladder cancer is one of the most prevalent and incident neoplastic conditions in the Western world. Its clinical management involves significant costs for health systems. Diagnosis and treatment are based on direct visualization of the disease and on detection of flat forms having no specific morphology and which are sometimes overlooked. Prognosis of NMIBC often depends on quality of transurethral resection and on early detection of undifferentiated flat forms. Cystoscopy using photosensitive substances such as 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinic acid (HAL) achieves overdetection rates of 29 % for bladder neogrowths and 59% for carcinoma in situ. This overdetection ability results in an increased disease-free survival and a longer time to the first relapse. Increased costs resulting from use of these resources are compensated by a lower number of or delayed performance of cystectomies, resections, and instrumentations. It is concluded that PDD should be universally used, rather than in high risk patients only.that has been shown in both animal studies and human tumors.
非肌肉浸润性膀胱癌是西方世界最常见和发病率最高的肿瘤疾病之一。其临床管理给卫生系统带来了巨大成本。诊断和治疗基于对疾病的直接可视化以及对无特定形态且有时被忽视的扁平形态的检测。非肌肉浸润性膀胱癌的预后通常取决于经尿道切除术的质量以及未分化扁平形态的早期检测。使用诸如5-氨基酮戊酸（5-ALA）或己基氨基酮戊酸（HAL）等光敏物质的膀胱镜检查对膀胱新生物的过度检测率为29%，对原位癌的过度检测率为59%。这种过度检测能力导致无病生存期延长和首次复发时间延长。使用这些资源导致的成本增加通过减少膀胱切除术、切除术和器械操作的数量或延迟其执行而得到补偿。结论是，光动力诊断（PDD）应普遍使用，而不仅仅用于高危患者。这在动物研究和人类肿瘤中均已得到证实。
