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

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

References

1. 1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011;61: 69-90.
2. 2. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet. 2009;374: 239-49.
3. 3. Witjes JA, Bruins M, Cathomas R, et al. European Association of Urology guidelines on Muscle-invasive and Metastatic Bladder Cancer: the 2019 Update. In. ISBN 978-94-92671-04-2. EAU Guidelines Office, Arnhem, The Netherlands. http://uroweb.org/guidelines/compilations-of-all-guidelines/
4. 4. Spiess PE, Agarwal N, Bangs R, et al. Bladder cancer, version 5.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15:1240–67.
5. 5. Tritschler S, Mosler C, Tilki D, et al.Interobserver variability limits exact preoperative staging by computed tomography in bladder cancer.Urology 2012;79(6):1317-21.
6. 6. Lim CS, Tirumani S, van der Pol CB, et al.Use of Quantitative T2-Weighted and Apparent Diffusion Coefficient Texture Features of Bladder Cancer and Extravesical Fat for Local Tumor Staging After Transurethral Resection.AJR Am J Roentgenol. 2019 Mar 12:1-10. doi: 10.2214/AJR.18.20718. [Epub ahead of print].
7. 7. Husillos AA, Rodríguez FE, Herranz AF, et al. The need for re-TUR of the bladder in non-muscle invasive bladder cancer: risk factors of tumor persistence in re-TUR specimens. Minerva Urol Nefrol. 2014;66:233-40.
8. 8. Tritschler S, Mosler C, Tilki D, Buchner A, Stief C, Graser A.Interobserver variability limits exact preoperative staging by computed tomography in bladder cancer. Urology 2012;79(6):1317-21.

9. 9. Schiffmann J, Sun M, Gandaglia G, et al.Suboptimal use of neoadjuvant chemotherapy in radical cystectomy patients: A population-based study.Can Urol Assoc J 2016;10(3-4):E82-6.
10. 10. Ueno Y, Takeuchi M, Tamada T, et al. Diagnostic Accuracy and Interobserver Agreement for the Vesical Imaging-Reporting and Data System for Muscle-invasive Bladder Cancer: A Multireader Validation Study.Eur Urol. 2019;76(1):54-56. doi: 10.1016/j.eururo.2019.03.012. Epub 2019 Mar 26.
11. 11. Paik ML, Scolieri MJ, Brown SL, et al. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol 2000; 163: 1693–96.
12. 12. Voges GE, Tauschke E, Stöckle M, et al. Computerized tomography: an unreliable method for accurate staging of bladder tumors in patients who are candidates for radical cystectomy. J Urol 1989; 142: 972–4.
13. 13. Baltaci S, Resorlu B, Yagci C, et al. Computerized tomography for detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma.Urol Int. 2008;81(4):399-402.
14. 14. Wood DP. Re: interobserver variability limits exact preoperative staging by computed tomography in bladder cancer. J Urol. 2013;189(3):843-4.
15. 15. Panebianco V, Narumi Y, Altun E, et al. Multiparametric magnetic resonance imaging for bladder cancer: development of VI-RADS (Vesical Imaging-Reporting and Data System). Eur Urol 2018;74:294–306.
16. 16. Kibel AS, Dehdashti F, Katz MD, et al. Prospective study of [18F] florodeoxyglucose positronemission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol 2009; 27:4314–20.
17. 17. Panebianco V, Barchetti F, de Haas RJ, et al.Improving Staging in Bladder Cancer: The Increasing Role of Multiparametric Magnetic Resonance Imaging.Eur Urol Focus 2016;2(2):113-21.
18. 18. Bartsch GC, Kuefer R, Gschwend JE, et al.Hydronephrosis as a Prognostic Marker in Bladder Cancer in a Cystectomy-Only Series. Eur Urol. 2007;51(3):690-8.
19. 19. Oh JJ, Byun SS, Jeong CW, et al. Association Between Preoperative Hydronephrosis and Prognosis After Radical Cystectomy Among Patients With Bladder Cancer: A Systemic Review and Meta-Analysis.Front Oncol 2019;9:158.
20. 20. Blute ML Jr, Kucherov V, Rushmer TJ, et al. Reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2) at first transurethral resection of bladder tumour is a significant predictor of subsequent recurrence and progression.BJU Int 2017;120(3):387-93.
21. 21. Zhang L, Wu B, Zha Z, et al.Concomitant carcinoma in situ may not be a prognostic factor for patients with bladder cancer following radical cystectomy: a PRISMA-compliant systematic review and meta-analysis.World J Urol. 2019 Mar 27. doi: 10.1007/s00345-019-02738-2. [Epub ahead of print]
22. 22. Nagase K, Tobu S, Kusano S, Takahara K, Udo K, Noguchi M.The Association between Metabolic Syndrome and High-Stage Primary Urothelial Carcinoma of the Bladder.Curr Urol 2018;12(1):39-42.
23. 23. Cantiello F, Cicione A, Salonia A, et al.Association between metabolic syndrome, obesity, diabetes mellitus and oncological outcomes of bladder cancer: a systematic review.Int J Urol 2015;22(1):22-32.
24. 24. Grimes N, Hannan C, Tyson M, Thwaini A. The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma. Can Urol Assoc J 2018;12(7):E345-8.
25. 25. Tangal S, Önal K, Yığman M, Haliloğlu AH. Relation of neutrophil lymphocyte ratio with tumor characteristics in localized kidney tumors.The New Journal of Urology 2018; 13 (1): 12-5.
26. 26. Lucca I, Jichlinski P, Shariat SF, et al.The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy: Validation and Meta-analysis.Eur Urol Focus 2016; 2(1):79-85.
27. 27. Potretzke A, Hillman L, Wong K, et al. NLR is predictive of upstaging at the time of radical cystectomy for patients with urothelial carcinoma of the bladder. Urol Oncol 2014; 32(5):631-6.
28. 28. Rajwa P, Życzkowski M, Paradysz A, Bujak K, Bryniarski P.Evaluation of the prognostic value of LMR, PLR, NLR, and dNLR in urothelial bladder cancer patients treated with radical cystectomy.Eur Rev Med Pharmacol Sci. 2018;22(10):3027-37.
29. 29. Zhu Z, Wang X, Wang J, et al.Preoperative predictors of early death risk in bladder cancer patients treated with robot-assisted radical cystectomy.Cancer Med 2019;8(7):3447-52.
30. 30. Schulz GB, Grimm T, Buchner A, et al.Prognostic Value of the Preoperative Platelet-to-leukocyte Ratio for Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer.Clin Genitourin Cancer 2017;15(6):e915-e921.