Real-world data reaffirm oncologic benefits of BLC for NMIBC

The use of blue light cystoscopy (BLC) was associated with a reduced risk of recurrence among patients with non–muscle invasive bladder cancer (NMIBC), according to findings from the BRAVO study, published in JU Open Plus.¹

According to the authors, this study is the largest real-world data comparison of 2 distinct retrospective cohorts.

Patients in the BLC group were more likely to receive intravesical BCG therapy or intravesical chemotherapy.

In total, the study included 626 patients from the Veterans Affairs Healthcare System. A 1:1 propensity score matching algorithm was used to compose 2 cohorts—patients who underwent BLC and patients who only underwent white light cystoscopy (WLC)—with 313 patients in each arm. Across both cohorts, the median age at diagnosis was 71 years, and 61% of patients had high-risk NMIBC. The median follow-up was 3.7 years.

Overall, 159 patients experienced a recurrence, of whom 64 (20%) were in the BLC arm and 95 (30%) were in the WLC arm. The risk of recurrence was significantly lower in the BLC arm, with a 3-year recurrence-free survival of 74.9% in the BLC arm vs 66.9% in the WLC arm (HR, 0.62; 95% CI, 0.45-0.86; P < .01).

According to the authors, “There was no association between risk of recurrence and receipt of intravesical BCG or intravesical chemotherapy.”

However, high-risk disease (HR, 2.25; 95% CI, 1.53-3.32) and older age (HR for every 10 years, 1.31; 95% CI, 1.09-1.59) were associated with a greater risk of recurrence.

Additionally, 38 patients experienced a bladder cancer progression, of whom 17 (5%) were in the BLC arm and 21 (7%) were in the WLC arm. The risk of disease progression on univariable analysis was not significantly different between the 2 arms (HR, 0.80; 95% CI, 0.42-1.51).

The authors noted, “In a multivariable adjusted analysis, patients who underwent BLC had a reduced risk of bladder cancer progression with a HR of 0.71 (95% CI, 0.37-1.38); however, statistical significance was not achieved.”

The authors found no association between progression and the receipt of intravesical BCG or intravesical chemotherapy. There was also no association between disease progression and age, sex, race, ethnicity, or smoking status. However, patients with high-risk disease had a 4-times increased risk of progression compared with those without high-risk disease (HR, 4.44; 95% CI, 1.49-13.25).

Patients in the BLC group were more likely to receive intravesical BCG therapy or intravesical chemotherapy. Specifically, 61% of patients in the BLC arm received intravesical BCG therapy, compared with 43% of patients in the WLC arm (P < .01). Similarly, 48% of patients in the BLC arm received intravesical chemotherapy, compared with 27% of patients in the WLC arm (P < .01). There was no significant difference in the rates of definitive treatment, with 8% of patients in the BLC arm and 6% of patients in the WLC arm receiving either radical cystectomy, radiation therapy, and/or systemic chemotherapy (P = .27).

In a sub-analysis, BLC detected higher grade NMIBC in 33 patients, compared with 9 patients for WLC (adjusted HR, 1.92; 95% CI, 1.23-3.02).

According to the authors, these findings support improved oncologic outcomes with BLC.

"Bladder cancer detection plays an important role in preventing cancer recurrence and optimizing appropriate treatment pathways, as previous research has shown that WLC alone may not comprehensively detect all NMIBCs,” concluded senior author Stephen B. Williams, MD, MBA, MS, FACS, FACHE, professor and chief of urology at the University of Texas-Medical Branch, in a news release on the findings.² “In this propensity-score matched cohort study, we found that the use of BLC vs. WLC alone was associated with significantly decreased 38% risk of recurrence. Our results are in line with the recent Cochrane review of nearly 3,000 patients across 15 randomized trials, where the authors found that that BLC may reduce the risk of bladder cancer recurrence by 34%.³ These data support current AUA/SUO guidelines recommending BLC usage in patients with NMIBC to increase detection and decrease recurrence.”

REFERENCES

1. Nasrallah AA, Das S, Evans C, et al. Oncologic outcomes of blue light cystoscopy in an equal access setting: Results of the BRAVO Study. JU Open Plus. 2025;3(3):e00017. doi:10.1097/JU9.0000000000000260

2. New BRAVO study publication reinforces clinical benefits of BLC in reducing risk of bladder cancer recurrence. News release. Photocure. March 14, 2025. Accessed March 19, 2025. https://www.prnewswire.com/news-releases/new-bravo-study-publication-reinforces-clinical-benefits-of-blc-in-reducing-risk-of-bladder-cancer-recurrence-302401805.html

3. Maisch P, Koziarz A, Vajgrt J, Narayan V, Kim MH, Dahm P. Blue versus white light for transurethral resection of non-muscle invasive bladder cancer. Cochrane Database Syst Rev. 2021;12(12):CD013776. doi:10.1002/14651858.CD013776.pub2