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

Year 2020, Volume: 15 Issue: 3, 139 - 148, 27.10.2020

İsmail Selvi , Halil Başar

https://doi.org/10.33719/yud.589118

Abstract

Objective: We
aimed to investigate the predictive value of additional parameters that may
improve diagnostic accuracy in predicting extravesical tumor invasion in
patients with muscle invasive transitional cell carcinoma after transurethral
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 retrospectively. Demographic,
pathological and clinical datas were recorded. Patients were
divided into two groups after pathological staging following radical
cystectomy: 26 patients without extravesical tumor invasion (pT2) and 17
patients with extravesical 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/lymphocyte ratio(MLR), mean platelet volume(MPV),presence of
preoperative hydronephrosis, concomitant carcinoma in situ(CIS), lymphovascular
invasion(LVI), depth of invasion in muscularis propria>50%, history of
previous tumor recurrence  were
significantly higher in Group II.However, 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 extravesical 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.

Conclusion: We
think that diagnostic accuracy in clinical staging before radical cystectomy
may be improved by using additional parameters other than CT or MRG.

Keywords

clinical staging , eGFR , extravesical tumor invasion , hydronephrosis , muscle invasive bladder cancer

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

Abstract

Amaç: Transüretral
mesane tümör rezeksiyonu (TUR-MT)
sonucu kas invaze transizyonel hücreli karsinom gelen hastalarda, klinik evrelemede
ekstravezikal tümör yayılımını tahmin etmede tanısal doğruluğu artırabilecek ek
klinik parametrelerin öngörü değerini araştırmayı amaçladık.

Gereç ve Yöntemler: Ocak 2009-Aralık 2016 tarihleri
arasında,TUR-MT patolojisi transizyonal hücreli kas invaze
mesane tümörü gelen ve klinik evrelemesi T2 veya T3 olarak değerlendirilip
radikal sistektomi yapılan 52 hastadan, verilerine tam olarak ulaşılabilen 43’ü
retrospektif olarak
değerlendirildi.Hastaların demografik, patolojik, 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 ayrıldı.

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/lenfosit oranı (PLO), monosit/lenfosit oranı (MLO), ortalama platelet
hacmi (MPV) anlamlı olarak daha yüksek
saptanırken; preoperatif hidronefroz varlığı, eşlik eden karsinoma in situ
(CIS), lenfovasküler invazyon (LVİ) varlığı, muskularis propria tabakasında
invazyon derinliğinin >%50 olması, önceki tümör rekürrensi öyküsü daha fazla
oranda saptandı. Tahmini glomerüler filtrasyon hızı (eGFR) ise anlamlı olarak
daha düşüktü.Çok değişkenli analizde, hidronefroz,
önceki rekürrens öyküsü, LVİ varlığı, muskularis propria invazyon derinliğinin >%50
olması, eGFR, NLO, PLO ve MLO değerlerinin ekstravezikal yayılım
varlığını öngörmede daha önemli faktörler olduğunu belirledik.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 kullanımı ile tanısal doğruluğun artabileceğini
düşünmekteyiz.

Keywords

ekstravezikal tümör yayılımı , eGFR , hidronefroz , kas invaze mesane kanseri , klinik evreleme

Supporting Institution

Yok

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