ISSN: 1300-0292
İndekslendiği Dizinler: SCIENCE CITATION INDEX EXPANDED
CINAHL, Index Copernicus,
Chemical Abstracts (CA),
Excerpta Medica / EMBASE
Dil: Türkçe, İngilizce
İçerik: Orijinal Araştırma, Derleme, Editöre Mektup, Olgu Sunumu, Tıp Eğitimi, Tıbbi Kitap İncelemeleri
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ORIGINAL RESEARCH ARTICLES |
The Evaluation Of Recurrence And Progression In High-grade Stage Pt1a-pt1b Urothelial Bladder Tumors
Dr. Fikret ERDEMİR,a Dr. Bekir S. PARLAKTAŞ,a Dr. Murat TUNÇ,b Dr. Murad ÇELTİK,b Dr. Engin KANDIRALI,b Dr. Faruk ÖZCANb
aÜroloji AD, Gaziosmanpaşa Üniversitesi Tıp Fakültesi, TOKATbÜroloji AD, İstanbul Üniversitesi İstanbul Tıp Fakültesi, İSTANBUL
Objective: Stage pT1 tumors constitute approximately 30% of superficial bladder cancers and they are generally high-grade. Controversy as to treatment and follow-up are still ongoing with regard to grade 3 pT1 tumors, a fact that has caused this tumor to occupy a special place in the spectrum of bladder tumors.
Material and Methods: Between January 1997 and December 2003, a total of 169 patients were treated with transurethral resection of bladder tumor (TUR-BT) and diagnosed as grade 3 pT1 tumors. 106 (62.7%) of these, whose tumors were classified as either pT1 or pT1b according to muscularis mucosa involvement, were enrolled in this study. All patients were evaluated by physical examination, urinary ultrasonography (USG) or intravenous urography (IVU), as well as with computed tomography (CT) or cystoscopy, if indicated. Clinical and pathological staging was done according to the 1997 TNM classification, and histological staging was performed according to WHO (World Health Organization, 1973) classification. Those tumors not manifesting invasion of the muscularis mucosa were accepted as pT1a, while involvement beyond muscularis mucosa was deemed pT1b.
Results: Mean age of the patients was 63.35 ± 11.4 (range: 36-81) years and the mean follow-up period was 45.6 (12-71) months. Of the 106 patients, 60 (56.6%) were placed in group pT1a and 46 (43.4%) were designated pT1b. Patients experiencing recurrence in the pT1a and pT1b groups were 23 (38.3%) and 36 (78.3%) respectively. Thirteen (21.7%) patients in pT1a and 22 (47.8%) patients in pT1b group showed progression. The difference between groups for these parameters was statistically significant (p< 0.05). The survival rates at the end of 3.5 years were found to be 98.3% and 76.08% for the pT1a and pT1b groups, respectively. The effects of tumor number, tumor size and carcinoma in situ (CIS) presence on recurrence and progression were evaluated within each group. As a result, it was determined that parameters such as tumor number and tumor size had no significant effect on the recurrence and progression rates of the groups (p= 0.500 and p= 0.499 for stage pT1a, respectively, and p= 0.562 and p= 0.582 for stage pT1b, respectively). Beyond these, the presence of CIS was indeed significant for recurrence and progression in the pT1a group (p= 0.023 versus p= 0.009, respectively), but not in group pT1b (p= 0.640 versus p= 0.299, respectively).
Conclusion: Due to the invasive nature of tumors in high-grade urothelial carcinoma, more aggressive treatment should be considered. Stage pT1 tumors especially should be subjected to close follow-up.Keywords: Bladder neoplasms, recurrence, disease progression, lymphoma, high gradeTurkiye Klinikleri J Med Sci 2005, 25:29-35
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