Department of Urology , Meishan People's Hospital, Meishan.
Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China.
Int J Surg. 2023 Oct 1;109(10):3169-3177. doi: 10.1097/JS9.0000000000000592.
This review aims to compare the efficacies of fluorescence cystoscopy, narrow-band imaging (NBI), and white light cystoscopy in the treatment and diagnosis of bladder cancer.
The authors searched PubMed, EMbase, Web of Science, and the Cochrane Library from January 1990 to April 2022. A total of 26 randomized controlled studies and 22 prospective single-arm studies were selected. Most patients had nonmuscle-invasive bladder cancer. The study protocol has been registered at PROSPERO.
In the pairwise meta-analysis, 5-aminolevulinic acid (5-ALA) reduced the short-term and long-term recurrence rates of bladder cancer compared with white light cystoscopy (WLC); however, no statistical difference was observed in intermediate-term recurrence rates (RR=0.79, 95% CI: 0.57-1.09). Hexaminolevulinic acid and NBI reduced short-term, intermediate-term, and long-term recurrence rates. The sensitivity of 5-ALA, hexaminolevulinic acid, NBI, and WLC for bladder cancer were 0.89 (95% CI: 0.81-0.94), 0.96 (95% CI: 0.92-0.98), 0.96 (95% CI: 0.92-0.98), and 0.75 (95% CI: 0.70-0.79), respectively; however, only NBI had the same specificity as WLC (0.74 vs. 0.74). Compared with WLC, 5-ALA improved the detection rate of carcinoma in situ and Ta stage bladder cancer but had no advantage in T1 stage tumors (OR=2.39, 95% CI:0.79-7.19). Hexaminolevulinic acid and NBI improved the detection rates of all nonmuscular-invasive bladder cancers. In the network meta-analysis, there was no significant difference in either recurrence or detection rates between 5-ALA, hexaminolevulinic acid, and NBI.
Fluorescence cystoscopy and NBI are advantageous for treating and diagnosing patients with nonmuscle-invasive bladder cancer.
本综述旨在比较荧光膀胱镜检查、窄带成像（NBI）和白光膀胱镜检查在膀胱癌治疗和诊断中的疗效。
作者检索了 1990 年 1 月至 2022 年 4 月期间的 PubMed、EMbase、Web of Science 和 Cochrane 图书馆，共纳入 26 项随机对照研究和 22 项前瞻性单臂研究。大多数患者患有非肌层浸润性膀胱癌。研究方案已在 PROSPERO 上注册。
在两两荟萃分析中，5-氨基酮戊酸（5-ALA）与白光膀胱镜检查（WLC）相比，降低了膀胱癌的短期和长期复发率；然而，中期复发率无统计学差异（RR=0.79，95%CI：0.57-1.09）。六氨基酮戊酸和 NBI 降低了短期、中期和长期复发率。5-ALA、六氨基酮戊酸、NBI 和 WLC 对膀胱癌的灵敏度分别为 0.89（95%CI：0.81-0.94）、0.96（95%CI：0.92-0.98）、0.96（95%CI：0.92-0.98）和 0.75（95%CI：0.70-0.79），但只有 NBI 的特异性与 WLC 相同（0.74 对 0.74）。与 WLC 相比，5-ALA 提高了原位癌和 Ta 期膀胱癌的检出率，但在 T1 期肿瘤中无优势（OR=2.39，95%CI：0.79-7.19）。六氨基酮戊酸和 NBI 提高了所有非肌层浸润性膀胱癌的检出率。在网络荟萃分析中，5-ALA、六氨基酮戊酸和 NBI 之间在复发率或检出率方面均无显著差异。
荧光膀胱镜检查和 NBI 有利于治疗和诊断非肌层浸润性膀胱癌患者。
