title: Fluorescence-guided bladder tumour resection: impact on survival after radical cystectomy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. georgios.gakis@web.de.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Theofanis
authors.initials: T
authors.lastname: Ngamsri
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Rausch
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mischinger
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Manuel Alexander
authors.initials: MA
authors.lastname: Schmid
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Fahmy Al-Sayed
authors.initials: FA
authors.lastname: Hassan
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Renninger
authors.affiliation: Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
keywords: Aminolevulinate; Bladder cancer; Hexaminolevulinate; Radical cystectomy; Survival; Transurethral bladder tumour resection