Mesane tümörlerinde nükleer matriks protein 22 (nmp22)'nin sistoskopik bulgular, tümörün evresi ve derecesi ile karşılaştırılması
Niuclear matrix protein 22 (nmp22) in the bladder tumor cpmparison with the findings of cystoscopy, stage and grade of the tumor
Yazar: BUĞRA BİLGE KESEROĞLU
Danışman: DOÇ. DR. RÜŞTÜ CANKON GERMİYANOĞLU
Sağlık Bakanlığı / Ankara Eğitim ve Araştırma Hastanesi / Üroloji Ana Bilim Dalı / Onkolojik Sitoloji Bilim Dalı
Derece: Tıpta Uzmanlık, 2001
Konu: Üroloji = Urology

Özet:
Mesane tümörlerinin kesin tanısı sistoskopi ve patolojik inceleme ile konulur. Tanı için invaziv bir yöntem olan sistoskopiye alternatif basit, invaziv olmayan, daha ucuz, duyarlılığı yüksek ve daha doğru sonuç verecek yöntemler araştırılmıştır. Bunlardan birisi de NMP'lerdir. NMP22'nin idrarda normalden fazla bulunmasının aşırı hücre büyümesi ve tümör varlığı ile ilişkili olduğu bildirilmiştir. Bu çalışmada, mesane tümöründe NMP22 testinin, sistoskopik bulgular, tümörün evre ve derecesi ile karşılaştırılması amaçlandı. Bu amaçla mesane tümörü tanısı almış 65´ı erkek, 28´i kadın 93 hastanın idrar NMP22 düzeylerine bakıldı ve sistoskopik bulgular, tümörün derecesi ve evresine göre değişiklik gösterip göstermediği incelendi. Sistoskopide; tümör sayısı, tümör büyüklüğü, tümörün primer veya tekrarlayan ve solid veya papiller olması durumuyla NMP22 değerleri karşılaştırıldı, istatistiksel olarak aralarındaki ilişki anlamsızdı (p>0.05). Sistoskopisinde tümör saptanan hastalara takiben TUR uygulandı. Patolojik spesimenler derecelerine göre 3 gruba ayrıldı. Derece 1 ve 2 arasında, derece 2 ile 3 arasında istatistiksel olarak anlamlı fark bulunmazken (p>0.05) derece 1 ile 3 arasında ki fark anlamlı bulundu (p0,05) Ta ile diğer evreler arasında ve T1 ile T2, T3 arasında anlamlı fark saptandı.

Abstract:
The frequency of bladder cancer is third in men, tenth in women among the all malignancy. Macroscopic or microscopic hematuria is present in 85-90% of the patients. Urine analyse, radiological evaluation, cystoscopy and pathologic study are made for diagnosis. Simple, non-invasive, cheaper, more reliable and more sensitive methods were investigated as alternative to the cystoscopy that is an invasive technique, such as, urine cytology, flow cytometry, tissue plasminogen activator, CEA, Thomson Friedenreich antigen, ABH-O blood group antigens, bladder cancer antigen, proteolitic enzymes, plasminogen activators, extracellular matrix protein and receptors, cell adhesion proteins, epidermal and tumor growth factors and receptors, proving of the chromosome and genetic alterations, hyaluronic acide-hyaluronidase, fibrin and fibrinogen destructive products, telomerase were studied. Nuclear matrix protein is the one of these methods that can be determined. It was considered that the high level of NMP22 in urine was correlated with overgrowth of the cell and tumor. NMP22 is the part of the nucleus of the cell; it obtains the regulation of the gene expression, DNA replication and transcriptions. Cystoscopy is a gold standard to evaluate hematuria because of the bladder cancer. It obtains a macroscopic view, the chance of biopsy and histopathology study. But cystoscopy is an invasive method. Diminish the frequency of the cystoscopy for following up the bladder cancer, may be preferred by these patients. In this study, we compared the NMP22 that was so simple for diagnose and followed up of bladder cancer and cystoscopy to diagnose bladder cancer successfully. For this reason 93 patients, 65 male, 28 female, the average age was 53.6, that were diagnosed as a bladder cancer, were investigated according to whether the primer or recurrent bladder cancer, papillary or solid, single or multiple, the grade and stage of tumor. The cut-off value of NMP22 was 10 U/ml. Comparison was made among the tumor number, bigness, primer or recurrent, solid or papillary and the values of NMP22, the correlation was not significant statistically (p>0.05). TUR was performed after the recognition of tumor in cystoscopy. Pathologic specimens were separated in 3 groups according to the degrees. While the differences between degree I and II, degree II and III were not significant statistically (p>0.05), the difference between degree I and III was significant (p0.05). However, the differences was also determined between Ta and the other stages, T1 and T2, T3. Sensitivity 65%, specific 56%, false negative 35%, false positive 44%, positive determining 65%, negative determining 56% were confirmed. However, it showed that NMP22 was insufficient about the diagnosis of tumor and extension of the interval of the control cystoscopy. Key Words: Bladder tumor, cystoscopy, NMP22.