title: Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data.
abstract: BACKGROUND
  Studies on hexaminolevulinate (HAL) cystoscopy report improved detection of bladder tumours. However, recent meta-analyses report conflicting effects on recurrence.
  
  
  OBJECTIVE
  To assess available clinical data for blue light (BL) HAL cystoscopy on the detection of Ta/T1 and carcinoma in situ (CIS) tumours, and on tumour recurrence.
  
  
  METHODS
  This meta-analysis reviewed raw data from prospective studies on 1345 patients with known or suspected non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  A single application of HAL cystoscopy was used as an adjunct to white light (WL) cystoscopy.
  
  
  METHODS
  We studied the detection of NMIBC (intention to treat [ITT]: n=831; six studies) and recurrence (per protocol: n=634; three studies) up to 1 yr. DerSimonian and Laird's random-effects model was used to obtain pooled relative risks (RRs) and associated 95% confidence intervals (CIs) for outcomes for detection.
  
  
  CONCLUSIONS
  BL cystoscopy detected significantly more Ta tumours (14.7%; p<0.001; odds ratio [OR]: 4.898; 95% CI, 1.937-12.390) and CIS lesions (40.8%; p<0.001; OR: 12.372; 95% CI, 6.343-24.133) than WL. There were 24.9% patients with at least one additional Ta/T1 tumour seen with BL (p<0.001), significant also in patients with primary (20.7%; p<0.001) and recurrent cancer (27.7%; p<0.001), and in patients at high risk (27.0%; p<0.001) and intermediate risk (35.7%; p=0.004). In 26.7% of patients, CIS was detected only by BL (p<0.001) and was also significant in patients with primary (28.0%; p<0.001) and recurrent cancer (25.0%; p<0.001). Recurrence rates up to 12 mo were significantly lower overall with BL, 34.5% versus 45.4% (p=0.006; RR: 0.761 [0.627-0.924]), and lower in patients with T1 or CIS (p=0.052; RR: 0.696 [0.482-1.003]), Ta (p=0.040; RR: 0.804 [0.653-0.991]), and in high-risk (p=0.050) and low-risk (p=0.029) subgroups. Some subgroups had too few patients to allow statistically meaningful analysis. Heterogeneity was minimised by the statistical analysis method used.
  
  
  CONCLUSIONS
  This meta-analysis confirms that HAL BL cystoscopy significantly improves the detection of bladder tumours leading to a reduction of recurrence at 9-12 mo. The benefit is independent of the level of risk and is evident in patients with Ta, T1, CIS, primary, and recurrent cancer.
authors.affiliation: Department of Urology and Paediatric Urology, Julius-Maximilians University Medical Centre, Würzburg, Germany. Electronic address: Burger_M2@klinik.uni-wuerzburg.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Michael
authors.initials: M
authors.lastname: Droller
authors.forename: Joerg
authors.initials: J
authors.lastname: Schmidbauer
authors.forename: Gregers
authors.initials: G
authors.lastname: Hermann
authors.forename: Octavian
authors.initials: O
authors.lastname: Drăgoescu
authors.forename: Eleanor
authors.initials: E
authors.lastname: Ray
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Burgués
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Patrice
authors.initials: P
authors.lastname: Jichlinski
authors.forename: Dieter
authors.initials: D
authors.lastname: Jocham
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003558:Cystoscopy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy
chemical_list: D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester
keywords: Bladder cancer; HAL blue light cystoscopy; Hexaminolevulinate