Comparing oncological outcomes and safety between photodynamic diagnosis-assisted and white-light transurethral resection in elderly patients with non-muscle invasive bladder cancer.

OBJECTIVES

This study aimed to assess the prognostic outcomes and risk of adverse events in elderly non-muscle invasive bladder cancer (NMIBC) patients receiving photodynamic diagnosis-assisted transurethral resection of bladder cancer (PDD-TURBT).

METHODS

This study retrospectively included 326 patients who were over 70 years old and received either PDD-TURBT (n = 114, PDD group) or white-light TURBT (n = 212, WL group). Oncological outcomes, namely recurrence-free survival (RFS) and progression-free survival (PFS), and adverse event profiles were compared between the two groups.

RESULTS

In the PDD and WL groups, the median RFS periods were not reached and 41.7 months (P < 0.001), and the median PFS periods were not reached and 160.2 months (P = 0.057), respectively. The Grey test which take account to overall death as a competing risk event revealed recurrence tended to decrease in PDD group (P = 0.050). The independent prognostic factors were determined by multivariate Cox regression analyses: WL-TURBT in RFS. After propensity score matching, statistically favorable RFS in the PDD group were shown (P = 0.018). The incidence of AST/ALT elevation and intraoperative hypotension (defined as systolic blood pressure ≤ 80 mmHg) were significantly higher in the PDD group than in the WL group (P = 0.003 and 0.003, respectively).

CONCLUSIONS

Prolonged RFS are expected for PDD-TURBT using oral 5-aminolevulinic acid in elderly NMIBC patients. However, the risks of liver injury and intraoperative hypotension are higher for PDD-TURBT.