Non-invasive bladder cancer in younger patients: Results of long-term follow-up

Year 2017, Volume: 12 Issue: 2, 32 - 37, 01.06.2017

Omer Bayrak , Haluk Sen Erkan Sadioglu İlker Seckiner Sakip Erturhan

Abstract

Purpose: The transitional cell carcinoma of the bladder (TCCB) is a rare disease below 35 years old patients. In our study, we aimed to present the treatment results and long-term follow-up process of younger patients. 

Materials and Methods: A 20 patients aged between 11-35 years were reviewed retrospectively. Intravesical epirubicin or mitomycin was administered to all of the patients within the first 12 hours in the postoperative period. The patiens were followed-up with cystoscopies according to the protocol. Abdominal computed tomography and Nuclear Matrix Protein-22 bladder control tests were performed once a year. 

Results: Amyloidosis mimicked bladder tumor was detected in one patient and this patient was excluded from the study. The mean age of the 9 male and 10 female patients was calculated as 25.1 (11-35) years and the mean duration of follow-up was calculated as 67.4 (42-96) months. All of the patients had single tumoral focus and mean tumor size was calculated as 2.55 (1-4) centimeters. According to the TNM classification, 2 (10.5%) patients were reported as benign papilloma, 15 (78.9%) patients as Ta, and 2 (10.5%) patients as T1. Intravesical Bacillus Calmette Guerin (BCG) was administered to 2 (10.5%) patients whose pathologies were recorded as T1. After sixth doses of intravesical BCG, relapses occurred in these 2 patients. Intravesical BCG therapy was started again, and no relapses were observed in subsequent follow-ups. NMP-22 test yielded positive results only in 2 (10.5%) patients with relapses. In addition, progression was not observed in any of patients below 35 years old. 

Conclucions: According to the related literature and the clinical results of the current study, TCCB appears as low grade in younger ages with better prognosis at long-term follow-up. 

Keywords

Bladder cancer , Pathology , Prognosis , Younger patient

Genç hastalarda invaziv olmayan mesane kanseri: Uzun dönem takip sonuçları

Abstract

Amaç: Mesanenin transizyonel hücreli karsinomu 35 yaş altında nadir görülen bir hastalıktır. Çalışmamızda, genç yaştaki hastaların uzun dönem tedavi sonuçlarını ve takiplerini sunmayı amaçladık. 

Gereç ve Yöntem: Yaşları 11-35 arası değişen, mesane tümörü tanısı almış 20 hastanın verileri retrospektif olarak incelendi. Tüm hastalara post-operatif ilk 12 saat içinde intravezikal epirubicin veya mitomicin kemoterapisi uygulandı. Hastalara evrelerine göre uygun protokolde kontrol sistoskopisi yapıldı. Hastalar yılda bir kez bilgisayarlı tomografi ve Nükleer Matriks Proteini-22 testi ile takip edildi. 

Bulgular: Bir hastada mesane tümörünü taklit eden amiloidoz saptandı ve hasta çalışma dışı bırakıldı. Çalışma kapsamında değerlendirilen 9 erkek ve 10 kadın hastanın ortalama yaşı 25.1 (11-35) yıl, ortalama takip süresi 67.4 (42-96) ay olarak hesaplandı. Hastaların tamamında tek odakta tümör mevcut olup, ortalama tümör boyutu 2.55 (1-4) santimetre olarak ölçüldü. TNM sınıflamasına göre 2 (%10.5) hastada benin papilloma, 15 (%78.9) hastada Ta patoloji, 2 (%10.5) hastada T1 patoloji rapor edildi. Patoloji sonucu T1 olarak rapor edilen 2 (%10.5) hastaya intravezikal Bacillus Calmette Guerin (BCG) tedavisi uygulandı. Altı haftalık BCG uygulaması sonrası relaps meydana gelen bu hastalara BCG tedavisi yeniden başlandı ve takiplerinde nüks görülmedi. NMP-22 testi sadece relapsı olan 2 hastada pozitif olarak saptandı. Ayrıca 35 yaş altındaki bu hastaların hiçbirinde progresyon da izlenmedi. 

Sonuçlar: Güncel literatürlerin ve mevcut çalışmamızın sonuçlarına göre; mesanenin transizyonel hücreli karsinomunun, genç hastalarda düşük dereceli ve uzun dönem takiplerde iyi prognozlu olduğu görülmektedir. 

Keywords

Mesane kanseri , Pa- toloji , Prognoz , Genç hasta

References

• 1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statis- tics, 2002. CA Cancer J Clin 2005; 55: 74-108.
• 2. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer 2013.
• 3. Gloeckler Ries LA, Reichman ME, Lewis DR, Hankey BF, Edwards BK. Cancer survival and incidence from the sur- veillance, epidemiology, and end results (SEER) program. The Oncologist 2003; 8: 541–52.
• 4. Abel PD. Prognostic indices in transitional cell carcinoma of bladder. Br J Urol 1988; 62: 103-9.
• 5. Konety BR, Suang T, Dhir R, et al. Detection of bladder cancer using a novel nuclear matriks protein, BCLA-4. Clin Can Res 2000; 6: 2618-25.
• 6. Madrid García FJ, Parra Muntaner L, Rivas Escudero JA, et al. Transitional cell bladder carcinoma in patients younger than 40 years of age. Arch Esp Urol 1998; 51: 991-4.
• 7. Sauter G, Algaba F, Amin M, et al. Tumours of the urinary system: non-invasive urothelial neoplasias. Lyon: IARCC Press 2004; p: 29-34.
• 8. Tomera KM. The NMP22® BladderChek® Test: Point of care technology with life and money-saving potential. Expert Rev Mol Diagn 2004; 4: 1-12.
• 9. Zaak D, Kriegmair M, Stepp H, et al. Endoscopic detection of transitional cell carcinoma with 5-aminolevulinic acid: results of 1012 fluorescence endoscopies. Urology 2001; 57: 690-4.
• 10. Agarwal N, Hussain M. Management of bladder cancer: current and emerging strategies. Drugs 2009; 18: 1173-87.
• 11. Wan J, Grossman HB. Bladder carcinoma in patients age 40 years or younger. Cancer 1989; 64: 178-81.
• 12. Kutarski PW, Padwell A. Transitional cell carcinoma of the bladder in young adults. Br J Urol 72: 1993; 749-55.
• 13. Fleshner NE, Herr HW, Stewart AK, Murphy GP, Mettlin C, Menck HR. National Cancer Data Base report on bladder carcinoma. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 1996; 78: 1505-13.
• 14. Jemal A, Siegel R, Ward E, Hao Y, Thun MJ. Cancer Statis- tics, 2009. CA Cancer J Clin 2009; 59: 225–49.
• 15. Yossepowitch O, Dalbagni G. Transitional cell carcinoma of the bladder in young adults: Presentation, natural history and outcome. J Urol 2002; 168: 61-6.
• 16. Benson RC Jr, Tomera KM, Kelalis PP. Transitional cell car- cinoma of the bladder in children and adolescents. J Urol 1983; 130: 54–5.
• 17. Madgar I, Goldwasser B, Nativ O, Hanai Y, Jonas P. Long- term follow up of patients less than 30 years old with transi- tional cell carcinoma of the bladder. J Urol 1988; 139: 933-4.
• 18. Paner GP, Zehnder P, Amin AM, Husain AN, Desai MM. Urothelial neoplasms of the urinary bladder occurring in young adult and pediatric patients: a comprehensive review of literature with implications for patient management. Adv Anat Pathol 2011; 18: 79-89.
• 19. Nomikos M, Pappas A, Kopaka MA, et al. Urothelial Carci- noma of the urinary bladder in young adults: presentation, clinical behavior and outcome. Adv Urol 2011; 2011: 1-4.
• 20. Migaldi M, Rossi G, Maiorana A, et al. Superficial papillary urothelial carcinomas in young and elderly patients: a com- parative study. BJU Int 2004; 94: 311–6.
• 21. Cho KS, Hwang TK, Kim BW, et al. Differences in tumor characteristics and prognosis in newly diagnosed Ta, T1 urothelial carcinoma of bladder according to patient age. Urology 2009; 73: 828–32.
• 22. Wang ZH, Li YY, Hu ZQ, et al. Does urothelial cancer of bladder behave differently in young patients? Chin Med J 2012; 125: 2643-8.
• 23. Fine SW, Humphrey PA, Dehner LP, Amin MB, Epstein JI. Urothelial neoplasms in patients 20 years or younger: a clinicopathological analysis using the world health organi- zation 2004 bladder consensus classification. J Urol 2005; 174: 1976–80.
• 24. Choi HS, Lee SI, Kim DJ, Jeong TY. Usefulness of the NMP22 Bladder Check Test for screening and follow-up of bladder cancer. Korean J Urol 2010; 51: 88-93.
• 25. Wen YC, Kuo JY, Chan KK, et al. Urothelial carcinoma of the urinary bladder in young adults-clinical experience at Taipei veterans general hospital. J Chin Med Assoc 2005; 68: 272-5.
• 26. Stanton ML, Xiao L, Czerniak BA, Guo CC. Urothelial tu- mors of the urinary bladder in young patients: a clinico- pathologic study of 59 cases. Arch Pathol Lab Med 2013; 137: 1337-41.
• 27. Comperat E, Stephane L, Roupret M, et al. Clinocopatho- logical characteristics of urothelial bladder cancer in pa- tients less than 40 years old. Wirchows Arch 2015; 466: 589-94.
• 28. Huang H, Li X, Jin J. Treatment of bladder transitional cell carcinoma in children: a single center experience from Chi- na. Arch Iran Med 2015; 18: 250-2.
• 29. Linn JF, Sesterhenn I, Mostofi FK, Schoenberg M. The mo- lecular characteristics of bladder cancer in young patients. J Urol 1998; 159: 1493-6.