Efficacy of fluorescent cystoscopy-assisted transurethral resection in patients with non-muscle invasive bladder cancer and quality of surgery: post-hoc analysis of а prospective randomized study.

Autor:	Rolevich A; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus.; Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan., Minich A; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Vasilevich V; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Zhegalik A; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Mokhort A; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Nabebina T; Department of Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Krasny S; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Polyakov S; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus., Sukonko O; Department of Urology and Pathology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus.
Jazyk:	angličtina
Zdroj:	Central European journal of urology [Cent European J Urol] 2019; Vol. 72 (4), pp. 351-356. Date of Electronic Publication: 2019 Sep 26.
DOI:	10.5173/ceju.2019.0003
Abstrakt:	Introduction: This paper aims to evaluate the influence of quality of transurethral resection in patients with non-muscle invasive bladder cancer on the benefit of fluorescent cystoscopy-assisted transurethral resection in the post hoc analysis of the single-center randomized controlled trial. Material and Methods: We retrospectively analyzed the results of the prospective randomized study assessing the efficacy of fluorescent cystoscopy-assisted transurethral resection. The quality of transurethral resection was defined on the basis of a separate retrospective study estimating the variability in recurrence risk for the individual surgeon. The subgroup analysis of fluorescent cystoscopy-assisted transurethral resection efficacy depending on surgical experience was performed. Results: Of 377 eligible patients, transurethral resection was performed in 365 (97%) by surgeons with available grading information. Two 'experienced' surgeons performed 238 (63%) of all transurethral resections and three 'less experienced' surgeons completed 127 (34%) surgeries. The two surgical groups were comparable with respect to basic prognostic factors and subsequent therapy. The median follow-up was 56 months.In the total cohort of patients, fluorescent cystoscopy significantly decreased the risk of recurrence with hazard ratio 0.58 (p = 0.004). In the 'experienced surgeons' subgroup the benefit of fluorescent cystoscopy was not significant (hazard ratio 0.81, p = 0.34), whereas the 'less experienced' subgroup showed a marked difference in favor of fluorescent cystoscopy-assisted transurethral resection (hazard ratio 0.31, p = 0.001), with a P-value for interaction of 0.021. Conclusions: Baseline quality of surgery may be a significant interacting factor affecting the magnitude of the benefit of fluorescent cystoscopy-assisted transurethral resection in patients with non-muscle invasive bladder cancer. Competing Interests: The authors declare no conflicts of interest. (Copyright by Polish Urological Association.)
Databáze:	MEDLINE
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