Comparison of hexaminolevulinate (HAL) -guided versus white light transurethral resection for NMIBC: A systematic review and meta-analysis of randomized controlled trials.

Abstract

PURPOSE:

We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on nonmuscle-invasive bladder cancer (NMIBC) clinical outcomes.

METHODS:

Systematic literature searches of PubMed, Embase, Web of Science, and the Cochrane database and reference lists were performed. A total of 12 randomized controlled trials (RCTs) of HAL fluorescent cystoscopy (FC) and WLC vs. white light cystoscopy alone for the diagnosis of initial or recurrent bladder cancer that reported bladder cancer recurrence, progression, recurrence-free survival (RFS), and other effects were selected for review.

RESULTS:

Our results included 2,775 patients identified for analysis and showed that the HAL group had a lower recurrence rate than the white light cystoscopy group with a statistically significant difference (RR=0.77, 95% CI 0.69-0.85. P < 0.05), and this advantage still existed for patients receiving intravesical chemotherapy. There was also a statistically significant difference in favour of fluorescent cystoscopy in recurrence-free survival and progression rate (HR=0.79, 95% CI 0.67-0.92. P < 0.05, RR = 0.63, 95% CI 0.43-0.94. P < 0.05, respectively). The time to first recurrence was not significantly different from that in the WLC group (SMD=0.73, 95% CI, -0.39-1.85. P = 0.2). And the HAL group did not have a significantly reduced residual tumor rate (RR=0.59, 95% CI 0.23-1.51. P = 0.27).

CONCLUSIONS:

Fluorescent cystoscopy was associated with a reduced risk of bladder cancer recurrence and reduced progression rate; it also has advantages for RFS. However, there was no significant difference in the rate of residual tumor and the time of first recurrence. More studies are needed to better understand the effects of the photosensitizer used on NMIBC patients.

• Authors: Hang Zhao, Panxin Peng, Zhenkai Luo, Hailong Liu, Junwei Sun, Xuming Wang, Qiang Jia, Zhihao Yang
• Journal: Photodiagnosis and photodynamic therapy (Photodiagnosis Photodyn Ther) Vol. 41 Pg. 103220 (Mar 2023) ISSN: 1873-1597 [Electronic] Netherlands
• PMID: 36462704 (Publication Type: Meta-Analysis, Systematic Review, Journal Article, Review)
• Copyright: Copyright © 2022. Published by Elsevier B.V.

Chemical References

• Photosensitizing Agents
• 5-aminolevulinic acid hexyl ester
• Aminolevulinic Acid

Topics

• Humans
• Photosensitizing Agents (therapeutic use)
• Neoplasm, Residual
• Neoplasm Recurrence, Local (prevention & control)
• Photochemotherapy (methods)
• Randomized Controlled Trials as Topic
• Urinary Bladder Neoplasms (drug therapy, surgery, diagnosis)
• Aminolevulinic Acid (therapeutic use)
• Cystoscopy (methods)