Article
The prognostic impact of hexaminolevulinate-based transurethral bladder tumor resection in patients with primary non-muscle invasive bladder cancer treated with radical cystectomy
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Authors
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Tina Schubert
- Uniklinik Würzburg
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Fahmy Hassan
- Uniklinik Würzburg
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Manuel Alexander Schmid
- Uniklinik Würzburg
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Markus Renninger
- Uniklinik Würzburg
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Arnulf Stenzl
- Uniklinik Würzburg
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Hubert Kübler
- Uniklinik Würzburg
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Georgios Gakis
- Uniklinik Würzburg
| Published: | May 17, 2018 |
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Outline
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Purpose: The aim of this study was to investigate whether hexaminolevulinate-based (HAL)-guided bladder tumor resection (TUR-BT) impacts on cancer-specific outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were treated with radical cystectomy (RC) for bladder cancer (BC) during their course of disease.
Methods: A total of 131 patients exhibiting NMIBC at primary diagnosis were treated with RC and bilateral pelvic lymphadenectomy. We retrospectively investigated whether patients had undergone any HAL-guided TURBT prior to RC. Chi-square test was used for univariable analysis of risk factors associated with performance of at least one HAL-TURBT. Kaplan-Meier analysis was conducted to evaluate cancer-specific (CSS) and overall survival (OS) using log-rank test. Uni- and multivariable Cox-regression analysis addressed risk factors for cancer-specific death. The median follow-up was 38 months (IQR: 13-56).
Results: Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with WL-TUR-BT only prior to RC. HAL-TUR-BT was associated with a higher number of TUR-BTs before RC (p=0.002), administration of intravesical immunotherapy (p=0.043) and absence of tumor-associated round cell infiltrates on RC specimens (p=0.05). A trend towards a lower utilization rate of palliative systemic chemotherapy after RC (p=0.10) was noted for patients who were treated with HAL-TURBT. The 3-year-CSS was 90.9% for patients with HAL- and 81.0% for patients with WL-TUR-BT (p=0.042). Likewise the 3-year OS was 86.6% for HAL- and 68.6% for WL-TUR-BT (p=0.038). In multivariable analysis, lymph node tumor involvement (p=0.007), positive surgical margins (p=0.001) and absence of HAL-TURBT (p=0.040) were independent predictors for cancer-specific death.
Conclusions: The present data suggest that the resection of NMIBC with HAL-guided TUR-BT may beneficially impact on cancer-specific outcomes of patients who will need to undergo RC during their course of disease. This may be due to improved risk stratification as the detection and resection of BC under HAL may allow more patients at risk of progression to be treated timely and adequately.
