Introduction:

Recent studies have shown conflicting evidence regarding the utility of blue light cystoscopy (BLC) guided resection of bladder tumor and impact on oncologic outcomes. We describe recurrence outcomes among a predominantly high-risk non-muscle invasive bladder cancer (NMIBC) patient cohort that underwent BLC vs. white light cystoscopy (WLC) in an equal access setting.

Methods:

We performed a retrospective cohort study among NMIBC patients within the Veteran Affairs (VA) that underwent BLC versus WLC from January 1, 1991 to January 31, 2023. A total of 337 BLC recipients were first identified and then compared to 337 WLC recipients using 1:1 propensity score matching. The variables that were used to calculate the propensity score between the cohorts included age at diagnosis, gender, race, ethnicity, location of bladder cancer diagnosed (within the VA vs. outside the VA), smoking status, clinical grade group, and BCG receipt. We determined recurrence rates following either BLC or WLC from date of bladder cancer diagnosis. We used the Kaplan-Meier method to estimate event-free survival and Cox regression to determine the association between type of cystoscopy (BLC vs. WLC) and recurrence.

Results:

A total of 674 patients in the matched analysis (337 BLC patients and 337 WLC patients) were included. There were 76 (11%) Black and 598 (89%) were non-Black patients, respectively. Median follow-up was 3.4 years and 2.0 years for the BLC and WLC cohorts, respectively. There was a total of 359 (54%) patients with either TaHG or T1 without CIS; 70 (10%) had CIS with or without TaHG or T1; and 245 (36%) had TaLG only. A total of 393 (58%) patients received BCG at any point during the study (Table 1). The risk of recurrence was significantly lower following BLC (Hazard Ratio (HR) 0.67; 95% Confidence Interval (CI) 0.51-0.89) than WLC (Figure 1). There was no significant difference recurrence (HR 1.09; 95% CI 0.70-1.70) by Black vs. non-Black race.

Conclusion:

In this study from an equal access setting in the VA, we observed significantly decreased risk of recurrence in patients who received a BLC compared to patients who only underwent WLC.

Funding: This study was conducted with the financial support of Photocure, Inc. Dr. Das was supported by the Patient-Centered Outcomes Research Training in Urologic and Gynecologic Cancers (PCORT UroGynCan): T32CA251072