Skip to main content

Advertisement

Log in

Fluorescence-guided bladder tumour resection: impact on survival after radical cystectomy

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether photodynamic diagnosis (PDD)-guided bladder tumour resection (TUR-BT) is of prognostic value in patients undergoing subsequent radical cystectomy (RC) for bladder cancer (BC).

Methods

In 224 consecutive patients who underwent RC and bilateral pelvic lymphadenectomy for BC between 2002 and 2010 (median follow-up 29 months [IQR 8–59]), we retrospectively investigated whether patients had previously undergone PDD-guided (hexaminolevulinate [HAL] vs. 5-aminolevulinate [ALA]) versus white light (WL)-TUR-BT. Kaplan–Meier analysis was used to estimate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) using log-rank and Cox regression model for uni- and multivariable analysis.

Results

Of the 224 patients, 66 (29.5 %) underwent HAL-, 23 (10.3 %) ALA- and 135 (60.2 %) WL-TUR-BT before RC. The 3-year RFS/CSS/OS was 77.8/83.9/74.0 % for HAL-, 53.6/74.5/60.9 % for ALA- and 52.4/59.7/56.5 % for WL-TUR-BT (p = 0.002/0.023/0.037 for HAL vs. WL/ALA). PDD-TUR-BT was associated with a higher number of TUR-BTs before RC (p < 0.001) and re-resections (p = 0.015), a longer time between the first TUR-BT and RC (p = 0.044) and a lower rate of post-operative systemic chemotherapy (p = 0.001). In multivariable analysis, performance of HAL-TUR-BT, pathologic tumour and nodal stage as well as soft tissue surgical margin status were independent predictors for RFS, CSS and OS.

Conclusions

This series indicates for the first time that HAL-guided TUR-BT is an independent predictor for improved survival after RC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Photons N, Campo MA, Popoxycz F, Gurny R, Lange N (2006) 5-Aminolevulinc acid derivates in photomedicine: characteristics, application and perspectives. Photochem Photobiol 82:994–1015

    Article  Google Scholar 

  2. Rink M, Babjuk M, Catto JW, Jichlinski P, Shariat SF, Stenzl A, Stepp H, Zaak D, Witjes JA (2013) Hexyl aminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: a critical review of the current literature. Eur Urol 64:624–638

    Article  PubMed  Google Scholar 

  3. Burger M, Grossman HB, Droller M et al (2013) Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol 64:846–854

    Article  PubMed  Google Scholar 

  4. Grossman HB, Stenzl A, Fradet Y et al (2012) Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy. J Urol 188:58–62

    Article  PubMed Central  PubMed  Google Scholar 

  5. Gakis G, Efstathiou J, Lerner SP et al (2013) ICUD-EAU international consultation on bladder cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 63:45–57

    Article  PubMed  Google Scholar 

  6. Witjes JA, Comperat E, Cowan NC et al (2013) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. doi:10.1016/j.eururo.2013.11.046

    Google Scholar 

  7. Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675

    CAS  PubMed  Google Scholar 

  8. Sobin LH, Wittekind C (2002) TNM classification of malignant tumors, 6th edn. Wiley, New York

    Google Scholar 

  9. Shim JW, Cho KS, Choi YD et al (2008) Diagnostic algorithm for papillary urothelial tumors in the urinary bladder. Virchows Arch 452:353–362

    Article  PubMed Central  PubMed  Google Scholar 

  10. Stenzl A, Cowan NC, De Santis M et al (2009) The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 85:815–825

    Article  Google Scholar 

  11. Shariat SF, Svatek RS, Tilki D et al (2010) International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int 105:1402–1412

    Article  PubMed  Google Scholar 

  12. Canter D, Guzzo TJ, Resnick MJ et al (2008) Hydronephrosis is an independent predictor of poor clinical outcome in patients treated for muscle-invasive transitional cell carcinoma with radical cystectomy. Urology 72:379–383

    Article  PubMed  Google Scholar 

  13. Stenzl A, Penkoff H, Dajc-Sommerer E et al (2011) Detection and clinical outcome of urinary bladder cancer with 5-aminolevulinic acid-induced fluorescence cystoscopy: a multicenter randomized, double-blind, placebo-controlled trial. Cancer 117:938–947

    Article  PubMed  Google Scholar 

  14. Stenzl A, Burger M, Fradet Y et al (2010) Hexaminolevulinate guided fluorescence cystoscopy reduces recurrence in patients with nonmuscle invasive bladder cancer. J Urol 184:1907–1913

    Article  PubMed Central  PubMed  Google Scholar 

  15. International Bladder Cancer Research Consortium, Bochner BH, Kattan MW, Vora KC et al (2006) Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer. J Clin Oncol 24:3967–3972

    Article  Google Scholar 

Download references

Conflict of interest

G. Gakis and A. Stenzl have received speaker honoraria from IPSEN Pharma GmbH, Ettlingen, Germany. All other authors have nothing to disclose. No funding was obtained for this study.

Ethical standard

This study was approved by the Local Ethics Committee, Tübingen, and conducted according to the Declaration of Helsinki and according to the STROBE statement (see supplementary material).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Georgios Gakis.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 110 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gakis, G., Ngamsri, T., Rausch, S. et al. Fluorescence-guided bladder tumour resection: impact on survival after radical cystectomy. World J Urol 33, 1429–1437 (2015). https://doi.org/10.1007/s00345-015-1485-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1485-8

Keywords

Navigation