Fluoreszenzdiagnostik bei Patienten mit nicht muskelinvasivem Harnblasenkarzinom: Ergebnisse einer Metaanalyse

Zusammenfassung

Fragestellung: In zahlreichen klinischen Studien zur photodynamische Diagnostik (PDD) beim Harnblasenkarzinom wurden heterogene Daten berichtet. Eine Metaanalyse prospektiver Studien wurde durchgeführt. Material und Methoden: Der Effekt einer PDD zusätzlich zur Weißlichtzystoskopie (WLC) bei Zystoskopie oder transurethraler Resektion (TUR) auf a) die Diagnose und b) den therapeutischen Erfolg bei primären oder rezidivierenden nicht Muskel-invasiven Harnblasenkarzinomen (NMIBC) wurde analysiert. Eine elektronische Datenbanksuche wurde durchgeführt. Eingeschlossen wurden Studien, in denen WLC mit PDD prospektiv verglichen wurde. Primäre Endpunkte waren zusätzliche Detektionsrate, Residualtumor bei Nachresektion und rezidivfreies Überleben. Ergebnisse: Mittels PDD wurden in der Analyse aller Patienten mit NMIBC 20 % [95 % Konfidenzintervall (KI): 8 bis 35 %] und der Patienten mit CIS 39 % (KI: 23 bis 57 %) signifikant mehr Tumor-positive Patienten detektiert. Residualer Tumor wurde bei Nachresektion nach PDD signifikant seltener gefunden (Odds Ratio 0,28, KI: 0,15 bis 0,52, p < 0,0001). Das rezidivfreie Überleben war nach 12 und 24 Monaten in den PDD-Gruppen signifikant länger als in den WLC-Gruppen. Schlussfolgerung: Durch PDD wurden mehr Harnblasenkarzinom-positive Patienten detektiert. Die besten Ergebnisse wurden bei CIS-Patienten gefunden. Die Diagnose mit PDD resultiert in einer kompletteren Resektion und einem längeren rezidivfreien Überleben. 

Abstract

Purpose: Heterogeneous results of single studies with photodynamic diagnosis (PDD) in bladder cancer have been reported. A metaanalysis of prospective studies has now been performed. Material and Methods: The effect of PDD in addition to WLC on a) the diagnosis and b) the therapeutic outcome of primary or recurrent non-muscle invasive bladder cancer (NMIBC) investigated by cystoscopy or transurethral resection was analysed. An electronic database search was performed. Trials were included if they prospectively compared WLC with PDD in bladder cancer. Primary endpoints were additional detection rate, residual tumour at second resection and recurrence-free survival. Results: Significantly more tumour-positive patients were detected with PDD in all patients with non-muscle invasive tumours (= 20 %) [95 % confidence interval (CI): 8 to 35 %] and in CIS patients (= 39 %) (CI: 23 to 57 %). Residual tumour was significantly less often found after PDD (odds ratio 0.28, CI: 0.15 to 0.52, p < 0.0001). Recurrence-free survival was significantly higher at 12 and 24 months in the PDD groups than in WLC only groups. Conclusions: More bladder tumour-positive patients are detected by PDD. Best results were found in CIS patients. Diagnosis with PDD results in a more complete resection and a longer recurrence-free survival.

Schlüsselwörter

ALA - Blasentumor - Blasenkrebs - HAL - Hexaminolevulinat - Metaanalyse - PDD - transurethrale Resektion - TUR - 5-Aminolevulinsäure

Key words

ALA - bladder neoplasms - bladder cancer - HAL - hexaminolevulinate - metaanalysis - PDD - transurethral resection - TUR - 5-aminolevulinic acid

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