Blue light cystoscopy significantly decreases risk of recurrence in NMIBC

Sanjay Das, MD

Investigators comparing blue light cystoscopy (BLC) and white light cystoscopy (WLC) found that BLC significantly decreased the risk of recurrence in patients with predominantly high-risk non–muscle-invasive bladder cancer vs WLC.¹

The findings were presented at the 2023 Society of Urologic Oncology Annual Meeting in Washington DC by Sanjay Das, MD, a post-doctoral research fellow at the University of California, Los Angeles. Das worked on the study with Stephen B. Williams, MD, MBA, MS, FACS, and coauthors.

For the analysis, the investigators performed a retrospective cohort study looking at patients with non–muscle-invasive bladder cancer within the Veterans Affairs system who underwent BLC vs WLC between January 1, 1991 and January 31, 2023. The investigators identified 337 patients who received BLC and compared them with 337 patients who received WLC using 1:1 propensity score matching.

“The variables used to calculate the propensity score between the cohorts included age at diagnosis, gender, race, ethnicity, location of bladder cancer diagnosed (within a VA facility vs outside VA), smoking status, clinical grade group, and BCG receipt,” the investigators wrote in their poster. Recurrence rates were determined following BLC or WLC from the date of bladder cancer diagnosis. The investigators utilized the Kaplan-Meier method to estimate event-free survival and Cox regression for determining the association between cystoscopy type and recurrence.

Out of the BLC and WLC cohorts, 76 (11%) were Black and 598 (89%) were non-Black patients. The median follow-up was 3.4 years for the BLC cohort and 2.0 years for the WLC cohort. 359 patients (54%) had either TaHG or T1 without carcinoma in situ (CIS), 70 patients (10%) had CIS with or without TaHG or T1, and 245 patients (36%) had TaLG only, according to the investigators.

The investigators reported that “the risk of recurrence was significantly lower following BLC (HR=0.67, 95% CI: 0.51-0.89) than WLC.” No significant difference in recurrence was seen when stratifying by Black vs non-Black race (HR=1.09. 95% CI: 0.70-1.70).

Commenting on the results, Das said the study “shows the continued benefit of blue light cystoscopy in a real-world setting.” In addition, he reported that more patients who received BLC also received treatment with BCG.

“That's expected though, since patients who receiving BLC tend to be at a higher risk of higher grade cancer, so their likelihood of receiving BCG is going to be higher as well. So we weren't too surprised by that,” Das told Urology Times.

Das told Urology Times that future research will aim to determine whether BLC influences progression.

“This multi-phased study shows Photocure’s commitment to support the evaluation of long-term clinical utility, cost effectiveness of BLC technology, and addressing disparities in the care of NMIBC using real-world evidence (RWE). Going forward, we expect further valuable insights through RWE analyses in collaboration with the Veterans Affairs Healthcare System,” said Photocure Chief Medical Officer Anders Neijber in a news release.²

References

1. Das S, Nasrallah A, Trustram Eve C, et al. Comparing white light versus blue light cystoscopy recurrence outcomes among non-muscle invasive bladder cancer patients in an equal access setting: a propensity scored matched analysis. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 163

2. SUO 2023 Meeting: New real world evidence shows significant decrease in risk of bladder cancer recurrence with blue light cystoscopy. News release. Photocure. December 1, 2023. Accessed December 1, 2023. https://www.photocure.com/news/suo-2023-meeting-new-real-world-evidence-shows-significant-decrease-in-risk-of-bladder-cancer-recurrence-with-blue-light-cystoscopy-4693977