Konecki Tomasz, Kutwin Piotr, Łowicki Roman, Juszczak Aleksandra Beata, Jabłonowski Zbigniew
1st Department of Urology, Medical University of Lodz, Lodz, Poland.
Photobiomodul Photomed Laser Surg. 2019 Sep;37(9):551-558. doi: 10.1089/photob.2019.4634. Epub 2019 Jul 24.
The objective of this study was to assess the effect of photodynamic diagnosis (PDD) using hexaminolevulinate on the diagnostic and therapeutic outcomes in nonmuscle invasive bladder cancer (NMIBC) patients. PubMed, Embase, and the Cochrane Library databases together with conference proceedings were searched. Recurrence-free survival was significantly higher at 3, 6, 9, and 12 months in the PDD groups than in the white light cystoscopy (WLC) groups with the cumulative values of differences in recurrence rates at different follow-up intervals ranging from 8% to 11%. PDD identified additional tumors in 25% of all NMIBC patients and in 35% of carcinoma (CIS) patients. In a patient-based analysis mean sensitivity of PDD versus WLC for all tumor detection was 94% and 84%, respectively. The assessed patient-based specificity was comparable for PDD and WLC in all types of tumors (55-56%); however, in CIS it was higher for PDD (82% vs. 72%). The meta-analysis confirms that PDD in conjunction with WLC detects significantly more tumors than WLC alone. Better diagnostic abilities of PDD transpose to significantly lower short-term recurrence rates after transurethral resection procedure and may improve treatment of NMIBC patients.
本研究的目的是评估使用六氨基乙酰丙酸的光动力诊断（PDD）对非肌层浸润性膀胱癌（NMIBC）患者诊断和治疗结果的影响。检索了PubMed、Embase和Cochrane图书馆数据库以及会议论文集。PDD组在3、6、9和12个月时的无复发生存率显著高于白光膀胱镜检查（WLC）组，不同随访间隔的复发率差异累积值在8%至11%之间。PDD在25%的所有NMIBC患者和35%的原位癌（CIS）患者中发现了额外的肿瘤。在基于患者的分析中，PDD与WLC对所有肿瘤检测的平均敏感性分别为94%和84%。在所有类型的肿瘤中，评估的基于患者的PDD和WLC特异性相当（55-56%）；然而，在CIS中，PDD的特异性更高（82%对72%）。荟萃分析证实，PDD联合WLC比单独使用WLC能检测到显著更多的肿瘤。PDD更好的诊断能力转化为经尿道切除术后显著更低的短期复发率，并可能改善NMIBC患者的治疗。
