Oncological Outcomes in High-grade pTa Bladder Cancer

Öz

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

Anahtar Kelimeler

• Bladder cancer
• survival
• progression

Yüksek Dereceli pTa Mesane Kanserinde Onkolojik Sonuçlar

Öz

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

Kaynakça

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