Mesane Kanseri Nedeniyle Transüretral Rezeksiyon Yapılan 177 Olgunun Retrospektif Analizi

Abstract

Amaç: Dünyada en sık görülen kanserler arasında dokuzuncu sırada yer alan mesane kanserleri, üriner sistemin en sık görülen maligniteleridir. 60 yaşın üzerinde ve erkeklerde daha sık görülürler. En sık görülen belirtisi hematüridir. En sık görülen histopatolojik tipi ürotelyal hücreli karsinomlardır. Oldukça yüksek rekürrens ve invazyon oranlarına sahiptirler. Mesane kanseri nedeniyle transüretral rezeksiyon (TURM) yapılan hastalar ilk iki yıl boyunca en az üç-dört ayda bir, sonraki üç yıl boyunca her altı ayda bir, daha sonra yılda bir defa klinik/sistoskopik olarak takip edilirler. Çalışmanın amacı, mesane tümörü tanısıyla TURM uygulanan vakaları ve bu vakaların nüks materyallerindeki re-TUR sonuçlarını invazyon ve histolojik grade açısından karşılaştırmalı olarak değerlendirmek, sonuçları literatürle paylaşmak, hastaların prognozunun belirlenmesine, klinik takibi ve tedavisine katkı sağlamaktır. Materyal ve Metot: Çalışmada üniversitesimizin patoloji arşivi kullanıldı. Mesane ürotelyal karsinom tanısı alan vakalar çalışmaya dahil edildi. 2013–2018 tarihleri arasında mesane tümörü tanısıyla TURM yapılan 177 olgu incelendi. Bu olguların parafin bloklarından alınan kesitler Hematoksilen-Eozin boyamayla değerlendirildi. İlk doku teşhisi ile re-TUR sonuçları karşılaştırıldı. Bulgular: Hastaların 153’ü erkek, 24’ü kadındı. Histopatolojik olarak 103 olguda yüksek dereceli, 74 olguda düşük dereceli ürotelyal karsinom mevcuttu. 66 vakada noninvaziv ürotelyal karsinom mevcuttu. 102 vakada lamina propria invazyonu, 9 vakada muscularis propria invazyonu saptandı. 46 (%26) vakada nüks olduğu saptandı. Tümör histolojik grade’i yüksek olan vakalarda ve invaziv vakalarda nüks oranları istatistiksel olarak anlamlı derecede yüksekti. Nüks eden 11 düşük grade’li vakanın 3 (%27,2) tanesinde rekürrens materyallerinde yüksek grade’li tümör saptandı. Nüks eden 11 noninvaziv vakanın 2 (%18,2)’sinde invazyon saptandı. Sonuç: Mesane TURM ve re-TUR sonuçları literatürle paylaşıldı. İlk doku teşhisi ile nüks materyalinde invazyon varlığı ve histolojik grade değişiklikleri mevcutsa, hastaların tedavi ve takibinin yeniden planlanması gerektiği vurgulandı.

Keywords

• mesane; transüretral rezeksiyon; ürotelyal karsinom; rekürrens

Retrospective Analysis of 177 Cases Treated with Transurethral Resection

Abstract

Aim: Bladder cancers are the ninth most common malignancies in the world. These are the most common malignancies of the urinary tract. The most common histological type of this cancer is urothelial cell carcinoma. It has very high rates of recurrence and invasion. The aim of this study is to evaluate the results of bladder TUR and re-TUR cases in terms of invasion and histological grade, to share the results with the literature, to determine the prognosis of patients and to contribute to the clinical follow-up and treatment. Material and Method: Pathology archive of Erzincan Binali Yıldırım University was used in this study. Cases with urothelial carcinoma of the bladder were included in the study. A total of 177 cases who underwent bladder TUR between 2013–2018 were examined. Sections from the paraffin blocks of these cases were evaluated with Hematoxylin-Eosin staining. Re-TUR results were compared with the first TUR diagnosis. Results: 153 of the patients were male and 24 were female. In 103 cases, the tumor was high-grade and 74 patients had low-grade tumor. Sixty-six cases had non-invasive urothelial carcinoma. Lamina propria invasion was detected in 102 cases and muscularis propria invasion in 9 cases. 46 (26%) cases had a recurrence. Recurrence rates were significantly higher in the cases with high-grade tumor and in the invasive cases. 3 (27.2%) of the recurrent 11 low-grade cases had a high-grade tumor in the recurrence material. The invasion was detected in 2 (18.2%) of 11 noninvasive cases. Conclusion: Bladder TUR and re-TUR results were shared with the literature. It was emphasized that if there is invasion and histological grade changes in the recurrence and the first TUR diagnosis, treatment and follow-up of patients should be re-planned.

Keywords

• bladder; transurethral resection; urothelial carcinoma; recurrence

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