Tekin KARSLIGİL, Sakıp ERTURHAN, Haluk ŞEN, Ahmet ERBAĞCI, Faruk YAĞCI

Mesane tümöründe nükleer matriks protein 22'nin tanısal ve öngörü değerinin sistoskopik ve patolojik bulgularla karşılaştırılması

Mesane tümörü tanısında ve tümör rekürrensinin saptanmasında nükleer matriks protein-22 (NMP-22)'nin sistoskopik ve patolojik bulgularla karşılaştırılmalı değerlendirilmesi amaçlandı. Çalışmaya toplam 89 hasta alındı. Hastalardan 39'u üroloji polikliniğine hematüri, sistizm ve/veya prostatizm semptomları ile başvuran mesane kanseri olma açısından yüksek riskli hastalardı (Crupl). Diğer 50 hasta ise daha önceden mesane tümörü teşhisi olan, transüretral rezeksiyon (TUR-M) yapılmış, intravezikal kemo/immünoterapi alan yada invaziv mesane kanseri grubunda radikal sistektomi yada sistemik kemoterapi planlanan hastalardı (Grup 2). Çalışmada her iki gruptaki hastaların idrarlarında ELISA yöntemi ile saptanan NMP-22 düzeyleri ölçümleri planlandı ve elde edilen verilerin istatistiksel değerlendirmesi sonucunda NMP-22'nin özgüllüğü ve duyarlılığı ortaya kondu. Ayrıca mesane tümörü saptanan olgularda; sistoskopik bulgularla, tümöre ait patolojik bulgular, NMP-22 düzeyleri ile karsılaştırılmıştır. Grup! için duyarlılık ve özgüllük değerleri sırasıyla %79, %88 grup 2 için ise%61, %47 olarak bulunmuştur. Ta ile Tl, Ti ile T2 ve T2 ile T3 arasında istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Ta ile T2, Ta ile T3, Tl ile T3 ve T4 ile diğer tüm gruplar arasındaki fark anlamlı idi (p0.05). Derece 1-3 ve 2-3 arasındaki farklar anlamlı bulundu (plcm, l-3cm, 3-8 cm ve >8cm), NMP-22 ortalama değerleri sırasıyla; 1 lü/ml, 15ü/ml, 34ü/ml ve >120 ü/ml bulundu. Tümör büyüklüğüne bağlı NMP-22 değerlerine bakıldığında; 0.05). 3-8 cm ve >8cm tümörlerde saptanan NMP-22 düzeyi ile diğer tümörler arasındaki fark anlamlı bulundu (p0.05). Çalışmamız NMP-22'nin mesane kanseri tanısı koymada yetersiz olduğu yönündedir. Ancak invaziv karakterde, yüksek dereceli ve büyük hacimli tümörlerin daha fazla oranda NMP-22 salgıladığı gözlenmiştir. NMP-22 pozitifliği, mesane tümörünün daha agresif nitelikte olduğunu göstermekle birlikte tanı ve takipte sistoskopiye üstünlüğü görülmemiştir.

Comparison of diagnostic and predictive value of nuclear matriks protein 22 with pathological and cystoscopic findings in bladder tumor

We planned comparative evaluation of diagnostic property and predictive value of NMP-22 in primary and reccurent bladder cancer according to cystoscopy and pathologic findings. A total of 89 patients were included into this study. Group I comprised 39 patients who admited to urology outpatient clinics with symptoms highly suggestive of bladder cancer (such as hematuria, cystism and/or prostatism symptoms). The rest of the patients (n:50) had diagnosed pathologically bladder cancer, who have been on maintanence therapy after TUR-M or waiting for radical cysto-prostatectomy or taking systemic chemoterapy (Group II). In our study methods, each group underwent determination of NMP-22 values in the urine with ELISA method and the results were evaluated statistically with sensitivity and specifity test. Additionally, the cystoscopic findings together with pathologic findings were compared with NMP-22 values in patients diagnosed as bladder tumor. The sensitivity and specifity of the NMP-22 test were 79% and 88% respectively in group I, it was determined as 61% and 47% respectively in group II. The differences of the NMP-22 values between Ta-T1, T1-T2, T2-T3 were not significant (p>0.05). The differences of the NMP-22 values between Ta-T2, Ta-T3, T1-T3 and between T4-overall T were significant (p< 0.05). While the differences between grade l-ll were not statistically significant (p> 0.05), the difference between grade I-MI and grade II - III were significant (p< 0.05). Being related with tumor size (8cm), the mean values of NMP-22 levels were found as 11 u/ml, 15u/ml, 34u/ml and >120u/ml respectively. The comparative evaluation was made according to the tumor volumes and macroscopic appearence. According to the tumor size was classified as 0.05), however 3-8cm and >8cm sized tumors were showed statistically significant differences from the other size of tumours (p0.05). Our results indicated that, NMP-22 test is not sufficient for diagnosis of bladder cancer. However, the secretion of NMP-22'was highest in invasive, high grade and high volumes tumors. The determination of NMP-22 in clinical condition must be anticipiated more agressive feature of the tumor, but it has been found that this state was not valuable than cystoscopy in dignosis and follow-up.

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