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Photodynamic diagnosis-assisted transurethral resection using oral 5-aminolevulinic acid decreases residual cancer and improves recurrence-free survival in patients with non-muscle-invasive bladder cancer 田岡, 利宜也 タオカ, リキヤ Taoka, Rikiya Matsuoka, Yuki 松岡, 祐貴 マツオカ, ユウキ Yamasaki, Mari 山﨑, 真理 ヤマサキ, マリ 可児, 尚弥 カニ, ナオヤ Kani, Naoya 本田, 智子 ホンダ, トモコ Honda, Tomoko 原田, 怜 ハラダ, サトシ Harada, Satoshi Tohi, Yoichiro 土肥, 洋一郎 トヒ, ヨウイチロウ Kato, Takuma 加藤, 琢磨 カトウ, タクマ Okazoe, Homare 岡添, 誉 オカゾエ, ホマレ 常森, 寛行 ツネモリ, ヒロユキ Tsunemori, Hiroyuki 上田, 修史 ウエダ, ノブフミ Ueda, Nobufumi 杉元, 幹史 スギモト, ミキオ Sugimoto, Mikio open access © 2022 The Author(s). This is an open access article under the CC BY licene. 5-aminolevulinic acid Photodynamic diagnosis Transurethral resection of bladder tumor Urothelial carcinoma Background: 5-aminolevulinic acid is a protoporphyrin IX precursor used for photodynamic diagnosis. We aimed to clarify the therapeutic benefits of orally administered 5-aminolevulinic acid for photodynamic diagnosis in transurethral resection for non-muscle-invasive bladder cancer in a real-world setting. Methods: From January 2009 to December 2020, patients with non-muscle-invasive bladder cancer who have undergone visually complete resection by initial transurethral surgery were included. Histopathologically confirmed residual and intravesical recurrent bladder cancer was retrospectively investigated and compared with transurethral resection using photodynamic diagnosis and conventional white light. Results: One hundred and fifteen patients who underwent photodynamic diagnosis-transurethral resection were compared with 346 patients who underwent white light-transurethral resection. The second transurethral resection revealed that the proportion of residual T1 and Ta bladder cancer was lower in the photodynamic diagnosis group than in the white light group (10.3% vs. 33.8%, P = 0.001). Additionally, the proportion of intravesical recurrence was lower in the photodynamic diagnosis group than in the white light group (9.6% vs. 41.9%, P < 0.001). Using 5-aminolevulinic acid-photodynamic diagnosis during transurethral resection of bladder tumor improved the cumulative intravesical recurrence-free survival (log-rank test: P < 0.001). Furthermore, multivariate analyses indicated that not using 5-aminolevulinic acid-photodynamic diagnosis was an independent predictive factor for residual bladder cancer (odds ratio, 6.16; 95% confidence interval, 2.10-18.0; P < 0.001) and intravesical recurrence (hazard ratio, 2.01; 95% confidence interval, 1.05-3.83, P = 0.034). Conclusions: Introducing 5-aminolevulinic acid-photodynamic diagnosis into transurethral resection reduces residual bladder cancer and improves the cumulative intravesical recurrence-free survival in patients with non-muscle-invasive bladder cancer, indicating its possible therapeutic benefits. Elsevier 2022-06 http://purl.org/coar/access_right/c_abf2 eng journal article VoR https://kagawa-u.repo.nii.ac.jp/records/2000511 35381368 https://doi.org/10.1016/j.pdpdt.2022.102838 AA12796004 1873-1597 Photodiagnosis and photodynamic therapy 38 https://doi.org/10.1016/j.pdpdt.2022.102838 text/html 2022-04-04