Üst ürı̇ner sı̇stem ürotelyal kanserı̇ nedenı̇yle cerrahı̇ yapılan hastalarda prognoz ve mesane rekürrensı̇ üzerine etkili faktörlerin araştırılması
Altan m. evaluation of the factors that effect the prognosis and bladder recurrences of the patients who had surgery for upper urinary tract urothelial carcinoma
Yazar: MESUT ALTAN
Danışman: PROF. DR. BÜLENT AKDOĞAN
Hacettepe Üniversitesi / Tıp Fakültesi / Üroloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2016
Konu: Üroloji = Urology

Özet:
1990-2015 tarihleri arasında üst üriner sistem ürotelyal kanseri (ÜÜS ÜK) nedeniyle cerrahi yapılan, tanı anında metastazı ve kasa invaze mesane kanseri (MT) öyküsü olmayan 140 hastanın verileri retrospektif olarak incelendi. Mesane rekürrensine ve sağkalıma etkili faktörler araştırıldı. Veriler SPSS 23.0 programında analiz edildi. Ortanca takip süresi 45 (3-324) ay, ortalama hasta yaşı 62,5 ± 11,6 yıl, kadın/erkek oranı ise 30/110 olarak bulundu. MT öyküsü ve yüksek tümör derecesi mesane rekürrensi için bağımsız risk faktörü olarak bulundu (p=0,006 ve p=0,002; sırasıyla). T evresi (≥T1), preoperatif anemi varlığı, yüksek tümör derecesi ve pozitif cerrahi sınır (PCS) kansere özgü sağkalım için bağımsız risk faktörleri olarak bulundu (p=0,035, p=0,001, p=0,039, p<0,001; sırasıyla). Preoperatif verilerine ulaşılan 113 hastalık alt grup analizinde nötrofil/lenfosit (NLO), lenfosit/monosit (LMO) ve trombosit/lenfosit (TLO) oranlarının sağkalım üzerine etkisi araştırıldı. NLO, LMO, TLO için mesane rekürrensi dışlanmış rekürrenssiz sağkalım sonlanma noktası alındı ve eşik değerler sırasıyla 2,89 (<2,9 ve ≥2,9), 2,88 (<2,9 ve ≥2,9), 149,4 (<150 ve ≥150) olarak bulundu. Yüksek NLO rekürrenssiz, kansere özgü ve hastalıksız sağkalımda; düşük LMO ise rekürrenssiz ve kansere özgü sağkalımda bağımsız risk faktörü olarak bulundu. Yüksek T evre ve derecesi, preoperatif anemi varlığı, PCS kansere özgü sağkalım için önemli risk faktörleridir. MT öyküsü veya yüksek dereceli tümörü olanlar postoperatif mesane rekürrensleri için daha dikkatli takip edilmelidir. Ayrıca NLO ve LMO sağkalım ve rekürrens için bağımsız birer preoperatif prognostik faktörlerdir.

Abstract:
Data of 140 patients, who had surgery for primary upper urinary tract urothelial carcinoma (UUT UC) without metastasis and/or invasive bladder carcinoma (BC) at the time of diagnosis from 1990 to 2015 analysed retrospectively. Factors affecting the bladder carcinoma recurrence and survival rates were evaluated. Statistical analyses was done with SPSS 23.0 statistic programme. Median follow up and mean age were 45 (3-324) months and 62.5±11.6 years, respectively. Male to female ratio was 110/30. Previous BC history and high grade UUT UC tumor history were independent risk factors for BC recurrence (p=0.006 and p=0.002; respectively). High tumor stage (≥T1), presence of anemia, high grade and positive surgical margin status were found to be independent risk factors for cancer specific survival (p=0.035, p=0.001, p=0.039, p<0.001; respectively). The effect of neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR) and platelet/lymphocyte (PLR) ratios' on survival was evaluated on 113 patients who had complete data. Cut-off values of NLR, LMR, PLR were calculated for recurrence free UUT UC survival, BC recurrence was excluded (2.89 (<2.9 and ≥2.9), 2.88 (<2.9 and ≥2.9), 149.4 (<150 and ≥150), respectively). High NLR is found to be an independent risk factor for recurrence free, cancer specific and disease free survival. Lower LMR value was an independent risk factor for recurrence free and cancer specific survival rates. Higher tumor stage and grades, presence of anemia, positive surgical margin were important risk factors for cancer specific survival. Patients with previous BC history or high grade UUT UC tumors must be followed more vigilantly since increased risk of bladder recurrences. NLR and LMR are independent preoperative prognostic risk factors for survival and recurrence.