To evaluate the long-term tumour recurrence, progression and cancer-specific mortality of patients following holmium laser ablation of non-muscle invasive bladder cancer (NMIBC) under topical anaesthesia. To identify variables that help to predict risk of tumour recurrence, progression and cancer-specific mortality.
A prospective study of 251 consecutive patients with 399 recurrent NMIBC who underwent outpatient Ho:YAG laser ablation under topical anaesthesia was carried out between September 2006 to September 2018. All patients underwent primary TURBT to obtain histology. All patients completed a patient satisfaction questionnaire and visual analogue scale (VAS) for procedure-related pain.
All 251 patients were analysed with an average age of 75.2 years and follow-up of 69.8 months. The majority of patients had multiple comorbidities with an ASA of 3 or 4. The proportion of tumour grade 1,2 & 3 disease and tumour stage Ta and T1 was 43.4%, 41.5%, 15.1%, 78.5% and 21.5% respectively. Overall 57.8% of patients had at least one tumour recurrence with an average time of 16.3 months. Risk factors were tumour grade, number of tumours at time of first laser ablation, and tumour stage. 19.1% of patients demonstrated tumour progression with an average time of 51 months. Only 5.6% of patients had progression to MIBC and the cancer specific mortality (CSM) rate was 5.2% with an average time to death of 71.2 months. Risk factors for CSM were tumour grade, stage, and patients age. The average VAS for pain was 0.6 out of 10 with all patients willing to have the procedure repeated if required.
Laser ablation of NMIBC is a safe, effective and well tolerated long-term option for patients, particular in those that have moderate to severe co-morbidities. The long-term cancer outcomes are best for younger patients with primary low grade and low stage disease.
Journal of endourology. 2019 Aug 21 [Epub ahead of print]
Maitrey Padmasambhav Darrad, Jah Syed, Zeba Ahmed, Haider A Syed
University Hospitals Birmingham NHS Foundation Trust, 1732, Urology , Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland; ., University Hospitals Birmingham NHS Foundation Trust, 1732, Urology , Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland; ., University Hospitals Birmingham NHS Foundation Trust, 1732, Urology , Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland; ., University Hospitals Birmingham NHS Foundation Trust, 1732, Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland; .