Mesane kanserinde yaş ve cinsiyetin klinik-patolojik sonuçlar üzerindeki belirleyici rolü

Amaç: Çalışmamızda yaş ve cinsiyetin mesane kanserli olgularda klinik ve patolojik özellikler üzerindeki etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Çalışmaya, kliniğimizde primer mesane kanseri tanısı konulan ve verileri kaydedilmiş 329 olgu dahil edildi. Hastalar cinsiyetlerine göre ve 60 yaş altı ve üstü olacak şekilde gruplandırılarak primer tümör patolojik özellikleri, eşlik eden carsinoma in sitü varlığı, tümör derecesi ve ilk sistoskopideki nüks yönünden değerlendirildi. Bulgular: Çalışmamızda 42 bayan ve 287 erkek hasta mevcuttu (kadın erkek oranı 6,8:1). Kadın hastalarda T1 evresinde hastalık ve yüksek grade daha yüksek oranda gözlendi ve ilk sistoskopide daha yüksek nüks oranı gözlendi. Erkek hastalarda eşlik eden CIS kadınlara nazaran daha yüksek oranda tespit edildi. 60 yaş altındaki genç hastalarda T1 evresinde daha çok hasta mevcuttu. Genç hastalarda daha yüksek grade ve anlamlı fark gösteren CIS eşlik etmekteydi. Ek olarak yine genç hastalarda ilk sistoskopide nüks oranı daha yüksekti. Sonuç: Kadın hastalarda daha agresif tümör özellikleri gözlenmektedir. Erkeklerde yüksek oranda eşlik eden CIS; sigara kullanımı ile ilişkili olabilir. Genç hastalarda yüksek evre ve gradeli, yüksek riskli hastalık daha sık gözlenmektedir. Genç hastalarda bu bulgular ışığında daha agresif ve radikal tedavilere yönelmek uygun seçim olacaktır

The sıgnıfıcance of age and gender on clınıc-pathologıc outcomes of bladder cancer

Objective: Our aim was to evaluate the significance of gender and age on clinical and pathologic variables of patients with primary bladder cancer. Materials and method: A total of 329 patients with primary bladder cancer and complete data are included in the study. Patients were stratified according to gender and age above or below 60 years old. Histological features of primary bladder tumor, presence of carcinoma in situ, tumor grade and recurrence of tumor at first cystoscopy are evaluated in each group. Results: Forty-two female and 287 male patients were included in the study (male to female ratio: 6.8:1). High grade disease and T1 stage were more prevalent in females. Recurrence rate at first cystoscopy were higher in women. Concomitant CIS were higher in men. Young patients below 60 years old had more T1 disease; high tumor grade and concomitant CIS. Moreover tumor recurrence at first cystoscopy were more prevalent in patients younger than 60 compared to older subjects. Conclusions: More aggressive bladder tumor properties are observed in women. High rate of concomitant CIS may be related to smoking habits in men. Higher stages and high grade, i.e high risk tumors are more frequently observed in patients below 60 years old. Thus priority to radical and more aggressive treatment regimens should be considered in younger patients.

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1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer Statistics, 2009 CA Cancer J Clin 2009;59:225– 249.
2. Hayne 0, Arya M, Quinn Mj, et al. Current trends in bladder cancer in England and Wales. J Urol 2004;172: 1051-1055.
3. Hendricksen K, Witjes JA. Treatment of intermediaterisk non-muscle-invasive bladder cancer (NMIBC). Eur Urol 2007;6:800-808.
4. Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis). J Urol 2007; 178:2314–2330.
5. Messing EM. Urothelial tumors of the bladder. In Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA eds, Campbell- Walsh Urology, Ninth Edition, Chapter: 2423-2511.
6. Gloeckler Ries LA, Reichman ME, Lewis DR, Hankey BF, Edwards BK. Cancer Survival and Incidence from the Surveillance, Epidemiology, and End Results (SEER) Program. The Oncologist, 2003; 8: 541–552.
7. Hong SJ, Cho KS, Han M, et al. Nomograms for prediction of disease recurrence in patients with primary Ta, T1 transitional cell carcinoma of the bladder. J Korean Med Sci 2008; 23:428-433.
8. Sobin LH, Wittekind CH. TNM Classification of Malignant Tumours. 6th ed. New York, NY: Wiley Liss, 2002:- 199-202.
9. Eble JN, Epstein JI, Sesterhenn I (Eds). World Health Organization classification of tumors. Pathology and Genetics of the Urinary System and Male Genital Organs. Lyon, IARCC Pres, 2004.
10. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage TaT1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006; 49.466–475.
11. Shariat SF, John P, Sfakianos JP, et al. The effect of age and gender on bladder cancer: a critical review of the literature. BJU International 2009;105:300-308.
12. Svatek RS, Shariat SF, Dinney C, et al. Evidence-based gender related outcomes after radical cystectomy: results of a large multicenter study (abstract #1744). J Urol 2009; 181: 629.
13. Datta GD, Neville B, Datta NS, Earle C. Gender disparities in bladder cancer survival: an assessment of sociodemographic factors. AACR Meeting Abstracts 2006: B38.
14. Scosyrev E, Noyes K, Feng C, Messing E. Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer 2009; 115: 68–74.
15. Boorjian SA, Zhu F, Herr HW. The effect of gender on response to bacillus Calmette-Guérin therapy for patients with non-muscle-invasive urothelial carcinoma of the bladder. BJU Int 2010; 106:357-361.