Influence of the Presence of Muscularis Propria on Recurrence and the Quality of Transurethral Resection in Low-Grade, Stage pTa Bladder Tumors

Amaç Yeni kasa invaze olmayan mesane tümörlerinin standart tedavisi mesanenin transüretral rezeksiyonu (TURM) ve intravezikal kemoterapidir. Yetersiz tümör rezeksiyonu, erken nüks ve düşük evreleme gibi hastalığın seyrini değiştirecek durumları ortaya çıkarmaktadır. Bu nedenle kasa invaze olmayan mesane tümörlerinin tedavisinde kaliteli TURM önemli bir faktördür. Gereç ve Yöntem Primer mesane tümörü nedeniyle TURM olmuş 841 hasta çalışmaya alındı. Toplam 597 hasta bu kriterlerimize uymadığı için çalışmadan çıkarıldı. Grup 1'de patoloji spesmeninde müskülaris propria (MP) görülen hastalar bulunurken; grup 2, TURM örneğinde MP görülmeyen hastalardan oluşmuştur. Hastalar; cinsiyet, tümör sayısı, patoloji spesmenindeki tümör hacmi, MP durumu, nüks durumu, nüks zamanı ve progresyon açısından değerlendirildi. Bulgular Nüks eden 92 hastanın sadece 14'ünde (%15,2) MP bulunurken geriye kalan 78 (%84,8) hasta da MP görülmemiştir (p=0,004). Grup 1'de progrese olan hasta 4 (%14,2), grup 2'de 28 (%29) hasta olarak ortaya çıkmıştır (p=0,159). Tek değişkenli analizde, tümör multiplitesi (p=0,003) ve MP yokluğu (p=0,004) rekürrens üzerine etkili bulunmuştur. Çok değişkenli analizde yine bu iki parametre nüks üzerine etkili bulunmuştur (p=0,004). Sonuç Bu çalışmada düşük dereceli evre pTa tümörlerin patoloji örneklerinde MP varlığının kaliteli bir TURM'nin göstergesi olduğu ve nüksleri önlemede iyi yapılmış TURM'nin önemine dikkat çekilmiştir.

Düşük Dereceli Evre pTa Mesane Tümörlerinde Müskülaris Propria Durumunun Transüretral Rezeksiyon Kalitesi ve Rekürrens Üzerine Etkisi

Objective Transurethral resection (TUR) of the bladder and intravesical chemotherapy is the standard treatment option for non-muscle-invasive bladder tumors. Inadequate tumor resection results in early recurrence and staging inaccuracies, which all will change the course of the disease. High-quality TUR treatment is therefore an important factor in the treatment of non-muscle-invasive bladder tumors. In this study, we investigated the significance of detecting the presence of muscularis propria (MP) in pathology specimens of low-grade, stage pTa tumors in patients who were treated with TUR due to primary bladder tumors, with regard to recurrence, time to recurrence and progression. Materials and Methods Initially, 841 patients who were treated with TUR due to primary bladder tumors were enrolled in the study. A total of 597 patients were excluded from the study because they failed to meet the study criteria. Group 1 consisted of patients with MP detected in the pathology specimens; whereas group 2 consisted of patients whose TUR specimens did not include MP. The patients were evaluated with regard to gender, tumor number, presence or absence of MP, and recurrence status. Results MP was observed in only 14 (15.2%) of 92 patients with recurrence, but not in the remaining 78 (84.8%) (p=0.004). Progression occurred in 4(14.2%) patients of group 1 and 28 (29%) patients of group 2 (p=0.159). In univariate analysis, tumor multiplicity (p=0.003) and the absence of MP (p=0.004) were found to have effects on recurrence. In multivariate analysis, these two parameters were also found to be have effects on recurrence (p=0.004). Conclusion In this study, it was pointed out that MP presence in the pathology specimens of low-grade stage pTa tumors is an indicator of a high quality TUR and, a well-done TUR is important for the prevention of recurrence.

Kaynakça

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