Randomized Trial of Narrow-band Versus White-light Cystoscopy for Restaging (Second-look) Transurethral Resection of Bladder Tumors
Mené sur 254 patients atteints d'un cancer de la vessie sans envahissement musculaire, cet essai compare, du point de vue de la survie sans récidive à 2 ans, l'efficacité de deux modalités de résection transuréthrale, l'une ulitisant la cytoscopie en imagerie à bande étroite et l'autre la cytoscopie en lumière blanche
Narrow-band imaging (NBI) cystoscopy detects more bladder tumors than standard white-light imaging (WLI) cystoscopy, but it is unclear whether NBI improves transurethral resection (TUR) of bladder tumors. This study compares 2-yr recurrence-free survival (RFS) of patients with non–muscle-invasive bladder tumors following restaging TUR using NBI or WLI cystoscopy. Patients were randomized 1:1 to undergo NBI-assisted TUR (NBI-TUR) or WLI-assisted TUR (WLI-TUR). The main outcome was number of patients free of tumor recurrence after 2-yr follow-up and 2-yr RFS times. Of 254 patients, 127 underwent NBI-TUR and 127 had WLI-TUR. Within 2 yr, 22% of the patients in the NBI-TUR group recurred compared with 33% after WLI-TUR (p = 0.05). The mean RFS time was 22 mo (95% confidence interval [CI], 20–23) for the NBI-TUR group versus 19 mo (95% CI, 18–21) for the WLI-TUR group (p = 0.02). Limitations are that this was a single-surgeon study and that a 20% difference in the number of patients free of recurrence was not achieved, suggesting the study was underpowered. In addition, observer bias may have contributed to results because NBI-TUR was performed after both WLI and NBI cystoscopy was used to inspect the bladder. Although the results suggest reduced recurrence rates and improved RFS times after restaging NBI-TUR compared with WLI-TUR, a larger study is needed. Patient summary : Narrow-band imaging enhances visibility of bladder tumors over conventional white-light cystoscopy. This report compares transurethral resection of bladder tumors using narrow-band cystoscopy with white-light cystoscopy. The results show that narrow-band cystoscopy improves surgical removal of bladder tumors, which reduces the frequency of early and later tumor recurrences.