Maisch Philipp, Koziarz Alex, Vajgrt Jon, Narayan Vikram, Kim Myung Ha, Dahm Philipp
Department of Urology, University of Ulm, Ulm, Germany.
Department of Urology, Rechts der Isar Medical Centre, Technical University of Munich, Munich, Germany.
BJU Int. 2022 Dec;130(6):730-740. doi: 10.1111/bju.15723. Epub 2022 Apr 6.
To assess the effects of blue-light (BL)-enhanced transurethral resection of bladder tumour (TURBT) compared to white-light (WL)-based TURBT in the treatment of non-muscle-invasive bladder cancer (NMIBC).
Based on a published protocol, we performed a systematic search of multiple databases from their inception to March 2021. We included randomized controlled trials (RCTs) comparing blue-light (BL) TURBT to white-light (WL) TURBT. Our meta-analysis was based on a random-effects model. We assessed the quality of evidence on a per-outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
We included 16 RCTs involving a total of 4325 participants in this review. BL TURBT may reduce the risk of disease recurrence over time (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54-0.81; low-certainty evidence) depending on baseline risk. For participants with low-, intermediate- and high-risk NMIBC, this corresponded to 48 (66 fewer to 27 fewer), 109 (152 fewer to 59 fewer) and 147 (211 fewer to 76 fewer) fewer recurrences per 1000 participants when compared to WL TURBT, respectively. BL TURBT may also reduce the risk of disease progression over time (HR 0.65, 95% CI 0.50-0.84; low-certainty evidence) depending on baseline risk. For participants with low-, intermediate- and high-risk NMIBC, this corresponded to 1 (1 fewer to 0 fewer), 17 (25 fewer to 8 fewer), and 56 (81 fewer to 25 fewer) fewer progressions per 1000 participants when compared to WL TURBT, respectively.
Our findings suggest a favourable impact of BL TURBT on the risk of disease recurrence and progression; however, whether this risk reduction is clinically relevant greatly depends on the baseline risk of patients. We did not find an increase in severe surgical complications with BL cystoscopy, and we did not find any trial evidence on other, non-surgical adverse events.
评估蓝光增强经尿道膀胱肿瘤切除术（BL-TURBT）与基于白光（WL）的经尿道膀胱肿瘤切除术相比，在治疗非肌层浸润性膀胱癌（NMIBC）中的效果。
根据已发表的方案，我们对多个数据库从创建到2021年3月进行了系统检索。我们纳入了比较蓝光（BL）经尿道膀胱肿瘤切除术与白光（WL）经尿道膀胱肿瘤切除术的随机对照试验（RCT）。我们的荟萃分析基于随机效应模型。我们根据推荐分级、评估、制定和评价（GRADE）方法，逐个结果评估证据质量。
我们在本综述中纳入了16项随机对照试验，共涉及4325名参与者。蓝光经尿道膀胱肿瘤切除术可能会随着时间的推移降低疾病复发风险（风险比[HR]0.66，95%置信区间[CI]0.54 - 0.81；低确定性证据），这取决于基线风险。对于低、中、高风险的非肌层浸润性膀胱癌参与者，与白光经尿道膀胱肿瘤切除术相比，每1000名参与者中复发次数分别减少48次（少66次至少27次）、109次（少152次至少59次）和147次（少211次至少76次）。蓝光经尿道膀胱肿瘤切除术也可能会随着时间的推移降低疾病进展风险（风险比[HR]0.65，95%置信区间0.50 - 0.84；低确定性证据），这取决于基线风险。对于低、中`、高风险的非肌层浸润性膀胱癌参与者，与白光经尿道膀胱肿瘤切除术相比，每1000名参与者中进展次数分别减少1次（少1次至少0次）、17次（少25次至少8次）和56次（少81次至少25次）。
我们的研究结果表明蓝光经尿道膀胱肿瘤切除术对疾病复发和进展风险有有利影响；然而，这种风险降低是否具有临床相关性很大程度上取决于患者的基线风险。我们未发现蓝光膀胱镜检查会增加严重手术并发症，并且未找到关于其他非手术不良事件的任何试验证据。
