Early recurrence and the need for re-resection following Photodynamic diagnosis–assisted Transurethral Resection of Bladder Tumours: Multi-centre real-world experience of the UK PDD Users Group. (January 2021)

• Record Type: Journal Article
• Authors: Mariappan, Paramananthan; Bunce, Colin; Cresswell, Jo; Shamsuddin, Altaf; Crundwell, Malcolm; Donat, Roland; Hurle, Rhidian A; Zachou, Alexandra; Stewart, Sarah; Hartley, Louise J; Mostafid, Hugh
• Is Part Of: Journal of clinical urology. Volume 14:Number 1(2021)
• Page Start: 65
• Page End: 72
• Publication Date: 2021-01
• Subjects: Fluorescence cystoscopy -- hexaminolevulinate -- recurrence -- transitional cell carcinoma -- urinary bladder neoplasms -- urothelial carcinoma; Genitourinary organs -- Surgery -- Periodicals; Genitourinary organs -- Diseases -- Periodicals; Urology -- Periodicals; 616.6005
• DOI: 10.1177/2051415819890464
• Languages: English
• ISSNs: 2051-4158

Abstract

Objective: This study aimed to investigate the association between Photodynamic Diagnosis (PDD) with hexaminolevulinate (HAL) and the rate of complete resection and disease persistence at first follow-up cystoscopy for non-muscle-invasive bladder cancer (NMIBC) in UK real-world practice. Methods: Audit data were pooled from six UK centres where HAL PDD was used in patients with a new NMIBC diagnosis undergoing transurethral resection of bladder tumours (TURBT) since 2008. Patients received adjunctive intra-vesical therapy and surveillance in line with European and UK guidelines, including early re-resection in high-grade NMIBC. Results: PDD-assisted TURBT was done in 837 patients with new NMIBC. The detrusor muscle was present in 69.4% of cases. At early re-TURBT in 207 high-risk patients, 13.0% had residual disease. Multifocal disease was the most significant factor in increasing the rate of residual disease (odds ratio excluding cases of CIS=4.1; 95% confidence interval 1.5–11.3). The recurrence rate at first follow-up cystoscopy (RRFFC) was 10.6% (8.9% in patients with complete initial TURBT). In the historical cohort undergoing good-quality white-light TURBT, RRFFC was 31%; 40.5% of high-risk patients had residual disease at early re-TURBT. Conclusion: HAL PDD may increase the rates of complete resection, reducing the risk of early recurrence and the need for routine re-resection in high-grade NMIBC. Level of evidence: 2b.