Comparison of 3-month recurrence rates after white-light versus narrow-band imaging transurethral resection for non-muscle invasive bladder cancer: A prospective, randomized control trial

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Background: Narrow-band imaging [NBI] is a new imaging modality that filters white light into short bandwidths of blue light (415 nm) and green light (540 nm). This technology was developed to enhance the detection and visualization of bladder cancer. For this reason, a transurethral resection of a bladder tumor [TUR-BT] with NBI may reduce the 3-month recurrence rate when compared to a TUR-BT with standard white light imaging [WLI]. Objective: To evaluate the 3-month recurrence rate of NBI TUR-BT versus WLI TUR-BT for the treatment of non-muscle invasive bladder cancer [NMIBC] in the Thai population. Materials and Methods: A randomized, controlled trial of 123 patients suspected to have NMIBC was conducted between January 2015 and August 2016. The patients were randomized into standard WLI TUR-BT and NBI TUR-BT groups. Surveillance cystoscopy and urine cytology were evaluated at the 3-month follow-up period. The patients’ baseline characteristics, cancer-free rates, and complications were recorded. Results: Eighty-three TUR-BT were excluded due to the following, a synchronous upper urinary tract tumor, post-operative intravesical therapy before surveillance, a tumor too large to complete resection, a tumor was a benign lesion, muscle invasive disease, and lost follow-up patients. One hundred fifty eight TUR-BTs were performed during the study period. After exclusion, there were 44 NBI TUR-BTs and 31 WLI TUR-BTs, respectively. The mean age at enrollment was 75 years in the NBI TUR-BT group and 66 years in the WLI TUR-BT group. Tumor characteristics and complication rates were similar in both groups (p = 0.15 and 0.692, respectively). After the 3-month follow-up period, the recurrence rate was 31.8% (11 of 44 patients) in the NBI TUR-BT group and 61.3% (19 of 31 patients) in the WLI TUR-BT group (p = 0.011). Conclusion: This is the first study of NBI TUR-BT in the Thai population. The results demonstrated that using an NBI TUR-BT had significantly reduced recurrence rates three months after a TUR-BT for NMIBC and had comparable post-operative complications when compared to WLI TUR-BT.