Blue light cystoscopy decreases risk of recurrence, progression in NMIBC

Data from the BRAVO study presented at the 2024 American Urological Association Annual Meeting showed that blue light cystoscopy (BLC) was associated with improved clinical outcomes compared with white light cystoscopy (WLC) in patients with non–muscle-invasive bladder cancer (NMIBC) within the Veterans Affairs (VA) Healthcare System.¹

The median follow-up was 3.4 years for patients who underwent BLC and 2.0 years for patients who underwent WLC.

“The results of the BRAVO study performed within the VA health care system showed significant decreases in the risk of recurrence and progression, as well as the potential for improved overall survival in patients who received a BLC compared to patients who received WLC only,” said principal investigator Stephen B. Williams, MD, MBA, MS, FACS, FACHE, in a news release on the findings.² Williams is the chief of the division of urology in the department of surgery at the University of Texas Medical Branch in Galveston, Texas.

Findings from the propensity-scored matched analysis showed that the risk of recurrence was significantly lower for patients following BLC compared with WLC alone (multivariable-adjusted HR, 0.60; P = .003). A significantly increased risk of recurrence was observed with Increasing age and high-risk NMIBC.

The risk of progression was also significantly reduced for those who received BLC compared with those who received WLC (HR, 0.51). In total, 17 patients in the BLC cohort experienced a progression event, compared with 21 in the WLC cohort, translating to a progression-free survival rate of 93.3% (95% CI, 89.4%-95.8%) and 92.4% (95% CI, 88.5%-95.0%), respectively (P = .489). Patients with high-risk NMIBC had up to a 4-fold increased risk of progression.

Additionally, overall survival following BLC vs WLC was significantly improved (HR, 0.41; P < .001). In total, there were 35 deaths among patients who received BLC, and 54 deaths among patients who received WLC. Increasing age and high-risk NMIBC were associated with worse survival.

When taking into account propensity score, BCG, and definitive treatment, BLC was associated with improvements in recurrence (HR, 0.59) and overall survival (HR, 0.40) compared with WLC, but no difference in progression risk (HR, 0.56).

In total, the study included patients with NMIBC within the VA Healthcare System. Following propensity score matching, 313 patients who underwent BLC and 313 patients who underwent WLC were included for analysis. Among all patients, 393 (58%) received BCG at any point during the study, with 206 being in the BLC cohort and 187 in the WLC cohort.

All patients included in the study underwent BLC vs WLC between January 1, 1991, and January 31, 2023. The median follow-up was 3.4 years for patients who underwent BLC and 2.0 years for patients who underwent WLC. The median patient age was 71 (IQR, 65-75) in the BLC cohort and 72 (IQR, 66-76) in the WLC cohort.

Overall, Williams concluded in the news release,² “These findings demonstrate the benefit of BL-enhanced cystoscopy as part of comprehensive care for NMIBC patients, especially as improved tumor visualization helps to appropriately make determination of intravesical therapy use, such as BCG. The results are encouraging and consistent with prior clinical trial long-term oncological outcomes. It supports the generalizability of prior clinical trial results in the real-world clinical practice setting. The demonstrated impact on overall survival warrants future studies to better understand the oncologic benefit of BLC in NMIBC."

References

1. Das SK, Nasrallah A, Gu L, et al. Use of blue light cystoscopy among non-muscle invasive bladder cancer patients and outcomes in an equal access setting: A propensity scored matched analysis. Presented at: 2024 American Urological Association Annual Meeting. May 3-6, 2024, San Antonio, Texas. Abstract PD48-05

2. Bladder cancer: Long-term benefits of blue light cystoscopy and enhanced detection with HD technology unveiled at AUA 2024. News release. Photocure. May 7, 2024. Accessed May 9, 2024. https://www.prnewswire.com/news-releases/bladder-cancer-long-term-benefits-of-blue-light-cystoscopy-and-enhanced-detection-with-hd-technology-unveiled-at-aua-2024-302137789.html