Summary of findings 1. Blue light compared to white light for transurethral resection of NMIBC .
| Blue versus white light for transurethral resection of non‐muscle invasive bladder cancer | ||||||
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Population: people with non‐muscle invasive bladder cancer Setting: inpatient or outpatient Intervention: blue light transurethral resection Comparison of interest: white light transurethral resection | ||||||
| Outcome |
№ of participants (studies) |
Certainty of the evidence (GRADE) |
Relative effect (95% CI) | Anticipated absolute effects | What happens | |
| Assumed risk1 | ||||||
| White light |
Risk difference with blue light |
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|
Time to disease recurrence (absolute event rates based on 12 months follow‐up; MCID 5%) |
2994 (15 RCTs) | ⨁⨁◯◯ LOW a,b | HR 0.66 (0.54 to 0.81) | Low2 | Blue light TURBT may have little or no effect on the risk of recurrence in people at low risk, but may reduce the risk of recurrence in those at intermediate and high risk. | |
| 150 per 1000 |
48 fewer per 1000 (66 fewer to 27 fewer) |
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| Intermediate2 | ||||||
| 380 per 1000 |
109 fewer per 1000 (152 fewer to 59 fewer) |
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| High2 | ||||||
| 610 per 1000 |
147 fewer per 1000 (211 fewer to 76 fewer) |
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|
Time to disease progression (absolute event rates based on 12 months follow‐up; MCID 2%) |
2200 (9 RCTs) | ⨁⨁◯◯ LOW a,c | HR 0.65 (0.50 to 0.84) | Low2 | Blue light TURBT may have little or no effect on the risk of progression in people at low and intermediate risk, but may reduce the risk of progression in those at high risk. | |
| 2 per 1000 |
1 fewer per 1000 (1 fewer to 0 fewer) |
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| Intermediate2 | ||||||
| 50 per 1000 |
17 fewer per 1000 (25 fewer to 8 fewer) |
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| High2 | ||||||
| 170 per 1000 |
56 fewer per 1000 (81 fewer to 25 fewer) |
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|
Surgical complications, serious (up to 90 days; MCID 2%) |
525 (1 RCT) | ⨁⨁◯◯ LOW a,c | RR 0.54 (0.14 to 2.14) | 22 per 1000 |
10 fewer per 1000 (19 fewer to 25 more) |
Blue light TURBT may have little to no effect on serious surgical complications. |
|
Time to death from bladder cancer (absolute event rates based on 60 months follow‐up; MCID 2%) |
407 (1 RCT) |
⨁⨁◯◯ LOW a,c |
HR 0.55 (0.19 to 1.61) |
22 per 1000 |
10 fewer per 1000 (17 fewer to 13 more) |
Blue light TURBT may have little to no effect on the time to death from bladder cancer. |
|
Any adverse events (up to 90 days; MCID 5%) |
1375 (3 RCTs) | ⨁⨁◯◯ LOW d,e | RR 1.09 (0.88 to 1.33) | 397 per 1000 |
36 more per 1000 (48 fewer to 131 more) |
We are very uncertain how blue light may affect adverse events. |
|
Surgical complications, non‐serious (up to 90 days; MCID 5%) |
‐ | ‐ | Not estimable | ‐ | ‐ | We do not know how non‐serious surgical complications are affected as no data were reported for this outcome. |
1We provide absolute effect size estimates for time to recurrence and time to progression to reflect risk stratification in clinical practice. Corresponding data were not found for time to death from bladder cancer. Baseline risk for other outcomes is assumed to be similar. 2Baseline risk at 12 months taken from Sylvester 2006.
aDowngraded by one level for study limitations due to concerns about performance, attrition, and reporting bias. bDowngraded by one level for clinically relevant inconsistency (I2 > 60%). cDowngraded by one level for imprecision given that 95% CI is consistent with both no effect and clinically important reduction. dDowngraded by one level for study limitations due to concerns about performance and reporting bias. eDowngraded by one level for imprecision given wide 95% CI consistent with both large increase and large reduction of adverse events.
MCID: minimal clinically important difference
NMIBC: non‐muscle invasive bladder cancer