Meftun ÇULPAN, Ferhat KESER, Mehmet Çağlar ÇAKICI, Gokhan ATİS, Asıf YILDIRIM

Yüksek Dereceli pTa Mesane Kanserinde Onkolojik Sonuçlar

Amaç Primer Ta, high grade patolojili hastalarda onkolojik sonuçların değerlendirilmesi, nüks için olası risk faktörlerin belirlenmesi ve ikincil TUR (re-TUR) yapılmasının onkolojik sonuçlara olan etkisinin gösterilmesi amaçlandı. Materyal ve Metod Ocak 2000 ile Aralık 2020 tarihleri arasında kliniğimizde TUR-MT yapılan hastaların verileri retrospektif olarak incelendi. pTa, high grade veya G3 ürotelyal karsinom patolojisi olan hastalar çalışmamıza dahil edildi. Hastaların demografik verileri, yapılan TUR-MT operasyonlarına ait histopatolojik verileri, nüks ve progresyon gelişimi ve bunların süreleri tarandı. Hastalar öncelikle nüks saptanan ve saptanmayanlar olarak sonrasında ise re-TUR yapılanlar ve yapılmayanlar olarak iki gruba ayrıldı. Bulgular Toplam 72 hastadan 63’ü erkekti (%87,5). Ortanca 25 aylık takipte 21 hastada nüks, 4 hastada ise progresyon saptandı. On dört hastada (%66,7) nüks ilk bir yıl içerisinde gelişti. Nüks patolojilerinin büyük çoğunluğu pTa (%82) mesane tümörüydü. Kasa invaze olan 2 hastanın birine radikal sistektomi ve üriner diversiyon, diğer hastaya multimodal tedavi uygulandı. Nüks gelişen grupta mesleki kimyasal maruziyeti istatistiksel anlamlı daha fazlaydı (p=0,001). Re-TUR yapılan grupta 9 (%37,5) hastada nüks görülürken, yapılmayan grupta 12 (%25) hastada nüks görüldü (p=0,271). Re-TUR yapılan ve yapılmayan grup arasında nükssüz sağkalım açısından istatistiksel anlamlı farklılık saptanmadı (p=0,432). Sonuç Bu çalışma ile Ta, high grade mesane kanserlerinde mesleki kimyasal maruziyetlerinin nüks üzerine negatif etkisi gösterildi. 5 yıl sonrasında dahi nüks ve progresyon gözlenebilmektedir. Re-TUR yapılmasının nükssüz sağ kalım üzerine belirgin etkisi görülmese de bu konuda daha fazla hasta sayısına sahip çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

mesane kanseri, sağkalım, progresyon, Bladder cancer, survival, progression

Oncological Outcomes in High-grade pTa Bladder Cancer

Background: It was aimed to evaluate the oncological outcomes in patients with primary Ta, high grade patholo-gy, to determine possible risk factors for recurrence, and to show the effect of secondary TUR (re-TUR) on oncological outcomes.Materials and Methods: Data of patients who underwent TUR-BT in our clinic between January 2000 and De-cember 2020 were retrospectively analyzed. Patients with pTa, high grade or G3 urothelial carcinoma were included. The demographic and histopathological data, development of relapse and progression and their dura-tion time were scanned. The patients were divided into two groups, those with and without recurrence, and those with re-TUR or not. Comparison of categorical variables was done with Pearson chi-square test and Fisher's Exact test. In quantitative data, Student's t-test was used for normally distributed variables and Mann-Whitney U test was used for others. Type I error probability was accepted as α = 0.05 for all tests. Kaplan-Meier survival curves with 95% CI were used to determine the effect of re-TUR on bladder tumor recurrence.Results: Total of 63 patients were male (87.5%) among 72 patients. 21 patients had recurrence and 4 patients had progression at 25 months of followup. Recurrence occurred in 14 patients (66.7%) within the first year. The majority of recurrent pathologies were pTa (82%) bladder tumors. Radical cystectomy and urinary diversion were applied to one of 2 patients with muscle invasion, and multimodal therapy was applied to the other. Occu-pational chemical exposure was statistically significantly higher in the recurrent group (p = 0.001). There was no statistically significant difference in terms of recurrence-free survival between with and without re-TUR (p=0.432).Conclusions: This study demonstrated the negative effect of occupational chemical exposure on recurrence in highgrade pTa bladder cancers. Even 5 years after the first diagnosis, recurrence and progression can be ob-served.Key Words: Bladder cancer, survival, progression

Keywords:

Bladder cancer, survival, progression,

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