Impact of photodynamic diagnosis-assisted transurethral resection of bladder tumors on the prognostic outcome after radical cystectomy: results from PROMETRICS 2011.
OBJECTIVE
Results of a retrospective single-institution study recently suggested improved prognostic outcomes in patients undergoing photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) prior to radical cystectomy (RC). We sought to validate the prognostic influence of PDD-assisted TURBT on survival after RC by relying on a multi-institutional dataset.


METHODS
To provide a homogeneous study population, patients with organ metastasis at the time of RC and/or after neoadjuvant chemotherapy were excluded from analysis, which resulted in overall 549 bladder cancer (BC) patients from 18 centers of the Prospective Multicenter Radical Cystectomy Series 2011 (PROMETRICS 2011). To evaluate the influence of PDD conducted during primary or final TURBT on cancer-specific mortality (CSM) and overall mortality (OM) after RC, bootstrap-corrected multivariate Cox proportional-hazards regression models were applied (median follow-up: 25 months; IQR: 19-30). Sensitivity analyses were performed for both patients with pure urothelial carcinoma and patients undergoing one single TURBT only.


RESULTS
In 88 (16.0 %) and 100 (18.2 %) patients, PDD was used in primary and final TURBTs, respectively. In 335 (61.0 %) patients, a single TURBT was performed prior to RC; in 194 patients (35.3 %), TURBT had been performed in a different center. CSM and OM rates at 3 years were 32 and 40 %, respectively. Use of PDD during primary or final TURBT was no independent predictor of CSM or OM. These results were internally valid and were confirmed in sensitivity analyses.


CONCLUSIONS
PDD utilization during TURBT prior to RC does not independently impact the prognosis of BC patients after RC.
Department of Urology, St. Elisabeth-Hospital Straubing, St. Elisabeth-Straße 23, 94315, Straubing, Germany. matthias.may@klinikum-straubing.de.
Matthias
M
May
Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, Regensburg, Germany.
Hans-Martin
HM
Fritsche
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Malte W
MW
Vetterlein
Department of Urology, Marien-Hospital Düsseldorf, Düsseldorf, Germany.
Patrick J
PJ
Bastian
Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, Regensburg, Germany.
Michael
M
Gierth
Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Philipp
P
Nuhn
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Atiqullah
A
Aziz
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Margit
M
Fisch
Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
Christian G
CG
Stief
Department of Urology, University of Heidelberg, Heidelberg, Germany.
Markus
M
Hohenfellner
Department of Urology, University Hospital 'Carl Gustav Carus', Dresden University of Technology, Dresden, Germany.
Manfred P
MP
Wirth
Department of Urology, University Hospital 'Carl Gustav Carus', Dresden University of Technology, Dresden, Germany.
Vladimir
V
Novotny
Department of Urology, University of Rostock, Rostock, Germany.
Oliver W
OW
Hakenberg
Department of Urology, Marien-Hospital Herne, Ruhr-University of Bochum, Herne, Germany.
Joachim
J
Noldus
Department of Urology, St. Elisabeth-Hospital Straubing, St. Elisabeth-Straße 23, 94315, Straubing, Germany.
Christian
C
Gilfrich
Department of Urology, University of Ulm, Ulm, Germany.
Christian
C
Bolenz
Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, Regensburg, Germany.
Maximilian
M
Burger
Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
Sabine D
SD
Brookman-May
D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D011379:Prognosis; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D015996:Survival Rate; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*
Cystectomy; Hexaminolevulinate; Photodynamic diagnosis; Prognosis; Survival; Transurethral resection of bladder tumor; Urinary bladder neoplasms