Effects of fluorescent light-guided transurethral resection on non-muscle-invasive bladder cancer: a systematic review and meta-analysis

Abstract

What's known on the subject? and What does the study add? It was well known that FL-guided TURBT could reduce the residual rate of NMIBC, but our systematic review suggested that it was not superior to conventional WL-guided TURBT in diagnostic accuracy and it had no significant effect on short-term RFS and PFS.

Objective: To assess the diagnostic accuracy and therapeutic outcomes of fluorescent light (FL)-guided transurethral resection (TUR) in non-muscle-invasive bladder cancer (NMIBC).

Methods: A systematic search of PUBMED, EMBASE and Cochrane Library was performed to identify randomized controlled trials comparing the outcomes of FL- and white-light (WL)-guided TUR of bladder tumours (TURBT). Outcomes included tumour detection rate, false-positive diagnosis rate, carcinoma in situ (CIS) detection rate, residual tumour rate, recurrence-free survival (RFS) and progression-free survival (PFS). RevMan 5.1 software was used for the meta-analysis.

Results: Data from 14 studies, involving 4078 patients with suspected or proven NMIBC, were pooled and included in the meta-analysis. There was no significant difference in tumour detection rate (relative risk [RR] 0.99; 95% confidence interval [CI] 0.96-1.03; P = 0.64) and CIS detection rate (RR 0.82; 95% CI 0.67-1.02; P = 0.07) between the FL and the WL groups. The false-positive diagnosis rate of the FL group was higher than that of the WL group (RR 0.69; 95% CI 0.49-0.97; P = 0.03). The tumour residual rate was higher in the WL group than in the FL group (RR 2.77; 95% CI 1.47-5.02; P = 0.002). No significant differences were found between groups at 3-month follow-up (RR 1.15; 95% CI 0.79-1.66; P = 0.46) or 12-month follow-up (RR 0.86; 95% CI 0.70-1.06; P = 0.16) or in terms of either RFS or PFS at 12-month (RR 0.99; 95% CI 0.94-1.04; P = 0.57) and 24-month follow-up (RR 1.02; 95% CI 0.98-1.06; P = 0.35).

Conclusion: FL-guided TURBT was not superior to conventional WL in diagnostic accuracy. Although FL-guided TURBT had an advantage in reducing the residual tumour rate, it had no significant effect on short-term RFS and PFS.