Use of Photodynamic diagnosis (PDD) at primary TURB: Potential influence on recurrence and progression rates in NMIBC: a registry-based study using a country cohort
DOI:
https://doi.org/10.2340/sju.v60.43993Keywords:
Photodynamic diagnosis, primary Trans Urethral Resection of the Bladder (TURB), progression risk, recurrence riskAbstract
Objective: To investigate whether department-level use of photodynamic diagnosis (PDD) for primary transurethral bladder resections (TURBs) is associated with recurrence and progression rates in a non-selected, national cohort. Non-muscle invasive bladder cancer (NMIBC) has high global prevalence, and is characterized by high recurrence risk and risk of progression to muscle-invasive bladder cancer. Treatment effects and long-term outcomes rely on diagnostic accuracy, which may be enhanced using PDD for TURB. PDD-use in Denmark has varied between departments.
Material and Methods: We identified all Danish patients with primary NMIBC during 2011–2017 via the Danish National Patient Registry (DNPR) and divided them into four groups based on the treating department’s annual PDD use. We included 8,502 patients; 76% men, median age at diagnosis: 70 years (interquartile range [IQR]: 63, 77). Primary outcomes were recurrence- and progression risk differences (RDs) at 2 and 5 years depending on the PDD-exposure group. Results were additionally stratified by baseline pathological risk group.
Results: The PDD-use varied from <40% of primary TURBs in group 1 to >74% in group 4. Overall 2- and 5 years recurrence risks were 39.9% [95% CI: 38.8; 41.0] and 48.1% [95% CI: 46.9; 49.3], while risks of progression were 17.5% [95% CI: 16.7; 18.4] and 22.9% [95% CI: 21.9; 23.9]. PDD-exposure groups 2–4 had lower recurrence- and progression risks compared to group 1, most pronounced for high-risk NMIBC.
Conclusions: PDD-use in primary TURBs correlates with reduced 2- and 5 years recurrence- and progression risks in NMIBC. The PDD benefit was most noticeable in higher risk NMIBC. Photodynamic diagnosis, primary Trans Urethral Resection of the Bladder (TURB), progression risk, recurrence risk
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