Transüretral Rezeksiyon Sonrası Kas İnvaze Mesane Tümörlerinin Klinik Evrelemesinde, Tanısal Doğruluğu Artırabilecek Ek Parametreler

Amaç: Transüretral mesane tümör rezeksi-yonu (TUR-MT) sonucu kas invaze transizyonel hücreli karsinom gelen hastalarda, klinik evre-lemede ekstravezikal tümör yayılımını tahmin etmede tanısal doğruluğu artırabilecek ek kli-nik parametrelerin öngörü değerini araştırmayı amaçladık. Gereç ve Yöntemler: Ocak 2009-Aralık 2016 tarihleri arasında, TUR-MT patolojisi transizyo-nal hücreli kas invaze mesane tümörü gelen ve kli-nik evrelemesi T2 veya T3 olarak değerlendirilip radikal sistektomi yapılan 52 hastadan, verilerine tam olarak ulaşılabilen 43’ü retrospektif olarak değerlendirildi. Hastaların demografik, patolojik ve klinik verileri kaydedilerek, radikal sistektomi sonrası histopatolojik evrelemede ekstravezikal tümör yayılımı olmayan (pT2) 26 hasta Grup I, ekstravezikal tümör yayılımı olan (pT3) 17 hasta ise Grup II olarak isimlendirilerek iki gruba ay-rıldı. Bulgular: Ortanca yaşı 65 olan hastaların 40 (%93)’ı erkek, 3 (%7)’ü kadındı. Grup II’de ECOG skoru, ASA skoru, Charlson komorbidite indeksi (CCI), nötrofil/lenfosit oranı (NLO), platelet/len-fosit oranı (PLO), monosit/lenfosit oranı (MLO), ortalama platelet hacmi (MPV) anlamlı olarak daha yüksek; preoperatif hidronefroz varlığı, eşlik eden karsinoma in situ (CIS), lenfovasküler invaz-yon (LVİ) varlığı, muskularis propria tabakasında invazyon derinliğinin >%50 olması, önceki tümör rekürrensi öyküsü daha fazla oranda saptandı. Tahmini glome-rüler filtrasyon hızı (eGFR) ise anlamlı olarak daha düşüktü. Çok değişkenli analizde, hidronefroz, önceki rekürrens öyküsü, LVİ varlığı, muskularis propria invazyon derinliğinin >%50 ol-ması, eGFR, NLO, PLO ve MLO değerlerinin ekstravezikal yayı-lım varlığını öngörmede daha önemli faktörler olduğunu belir-ledik. ROC analizine göre, eGFR, MLO, PLO, NLO için kestirim değerleri sırasıyla 77.73 (AUC:0.805, p=0.001), 0.24(AUC:0.771, p=0.003), 116 (AUC:0.766, p=0.004), 2.07 (AUC:0.710, p=0.021) olarak hesaplandı. Sonuç: Radikal sistektomi öncesi klinik evrelemede BT veya MRG dışında kullanılabilecek çeşitli ek parametrelerin kullanı-mı ile tanısal doğruluğun artabileceğini düşünmekteyiz

Additional Parameters That May Improve Diagnostic Accuracy in Clinical Staging of Muscle Invasive Bladder Tumors After Transurethral Resection

Objective: We aimed to investigate the pre-dictive value of additional parameters that may improve diagnostic accuracy in predicting ex-travesical tumor invasion in patients with muscle invasive transitional cell carcinoma after transure-thral bladder tumor resection (TUR-BT). Material and Methods: The data of patients with muscle-invasive bladder tumor pathology on TUR-BT and who underwent radical cystectomy between January 2009 and December 2016 due to clinical stage T2 or T3 were evaluated retrospec-tively. Demographic, pathological and clinical da-tas were recorded. Patients were divided into two groups after pathological staging following radical cystectomy: 26 patients without extravesical tu-mor invasion (pT2) and 17 patients with extraves-ical tumor invasion (pT3). Results: Of the patients with a median age of 65, 40 (93%) were male and 3 (7%) were female. ECOG score, ASA score, Charlson comorbidity index (CCI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio(PLR), monocyte/lym-phocyte ratio(MLR), mean platelet volume(MPV), presence of preoperative hydronephrosis, con-comitant carcinoma in situ(CIS), lymphovascular invasion(LVI), depth of invasion in muscularis propria >50%, history of previous tumor recur-rence were significantly higher in Group II. How-ever, estimated glomerular filtration rate (eGFR) was significantly lower. In multivariate analysis, hydronephrosis, previous recurrence, presence of LVI, depth of invasion in muscularis propria >50%, eGFR, NLR, PLR and MLR were found to be independent predictors in predicting ex-travesical invasion. According to ROC analysis, cut-off values for eGFR, MLR, PLR, NLR were 77.73 (AUC:0.805, p=0.001), 0.24 (AUC:0.771, p=0.003), 116 (AUC:0.766, p=0.004), 2.07 (AUC:0.710, p=0.021), respectively.Conclusions: Despite all the many advances in technology, long-term encrusted stents lead to sepsis and loss of kidney function. We think that not forgetting is the best means of protection against encrusted stent-related complications. Conclusion: We think that diagnostic accuracy in clinical staging before radical cystectomy may be improved by using ad-ditional parameters other than CT or MRG.

Kaynakça

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Kaynak Göster

Yeni Üroloji Dergisi
  • ISSN: 1305-2489
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2005

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