Orta ve yüksek riskli kasa invaze olmayan mesane kanseri hastalarında intravezikal bcg yanıtını öngörebilecek klinik, patolojik ve inflamatuar faktörler
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
BCG (Bacillus Calmette Guerin) yalnızca rekürrensi değil aynı zamanda progresyon oranlarını azaltarak günümüzde kasa invaze olmayan mesane kanserinde (KİOMK) altın standart tedavi seçeneğidir. Ancak BCG cevabı birçok faktöre bağlı olarak değişkenlik göstermektedir. Çalışmamızda klinikopatolojik faktörlerin yanında; SII (Sistemik immün-inflamasyon indeksi), NLR (Nötrofil lenfosit oranı), PLR (Trombosit lenfosit oranı) ve LMR (Lenfosit monosit oranı) değerlerinin BCG cevabını öngörmedeki yeri incelendi. Ocak 2010 – Mart 2023 tarihleri arasında kliniğimizce takibi yapılmış 163 KİOMK hastası çalışmaya dahil edildi. Hastaların demografik, klinik, patolojik verileri, EAU risk grubu, Tur-m öncesi NLR, PLR, LMR ve SII değerleri incelendi. Hastalar BCG duyarlı ve cevapsız (refrakter) olmak üzere iki gruba ayrıldı. Gruplar arasında klinikopatolojik ve inflamatuar faktörler karşılaştırıldı. Ayrıca nüks ve progresyon durumuna göre ayrı ayrı gruplandırılarak inflamatuar parametreler karşılaştırıldı. Gruplar arasında cinsiyet, tümör evre ve derecesi, multifokalite, prostatik üretra ve mesane boynu tutulumu, histolojik alt tip ve primer/rekürren hastalık açısından anlamlı fark yoktu. Yaşlı hastalarda (>65), Üst üriner sistem tümörü (ÜÜST) hikayesi olanlarda, solid morfolojiye sahip ve CIS eşlik eden tümörlerde, re-TURm'da yüksek dereceli tümör olanlarda ve EAU yüksek risk grubundaki hastalarda daha yüksek oranda BCG cevapsızlığı izlendi. BCG cevapsız grupta SII, NLR ve PLR değerleri BCG duyarlı hastalara göre daha yüksekti. SII cut off değeri 561,9 olarak belirlendi. CIS, ÜÜST hikayesi, solid tümör morfoloji, re-TURm'da yüksek dereceli tümör varlığı, yüksek SII, NLR ve PLR değerleri BCG cevabı, nüks ve progresyonu öngörebilir. Bu hasta gruplarında intravezikal BCG tedavisi yerine radikal küratif tedavi seçenekleri daha çok tercih edilebilir. Anahtar Kelimeler: Mesane Kanseri, BCG Cevabı, İnflamatuar Faktörler, BCG Refraktör
BCG (Bacillus Calmette Guerin) is currently the gold standard treatment option in non-muscle invasive bladder cancer (NMIBC) by reducing not only recurrence but also progression rates. However, the BCG response varies depending on many factors. In our study, besides clinicopathological factors; SII (Systemic immune-inflammation index), NLR (Neutrophil-lymphocyte ratio), PLR (Platelet-lymphocyte ratio) and LMR (Lymphocyte-monocyte ratio) values in predicting BCG response was examined. Between January 2010 and March 2023, 163 patients with NMIBC who were followed up by our clinic were included in the study. Demographic, clinical and pathological data of the patients, EAU risk group, pre-Tur-m NLR, PLR, LMR and SII values were analyzed. The patients were divided into two groups as BCG naive and refractory. Clinicopathological and inflammatory factors were compared between the groups. In addition, inflammatory parameters were compared by grouping them separately according to recurrence and progression. There was no significant difference between the groups in terms of gender, tumor stage and grade, multifocality , prostatic urethra and bladder neck involvement, histological subtype, and primary /recurrent disease. A higher rate of BCG refractory was observed in elderly patients (>65), those with a history of upper urinary tract tumor (UTUC), tumors with solid morphology and accompanying CIS , high-grade tumor in re- TURm , and patients in the high-risk group of EAU. SII, NLR, and PLR values were higher in the BCG refractory group than in BCG naive patients. SII cut The off value was determined as 561,9. CIS, UTUC history, solid tumor morphology, presence of high-grade tumor in re- TURm, high SII, NLR and PLR values may predict BCG response, recurrence and progression. In these patient groups, radical curative treatment options may be preferred rather than intravesical BCG treatment. Key words: Bladder Cancer, BCG Response, İnflammatory Factors, BCG Refractor
BCG (Bacillus Calmette Guerin) is currently the gold standard treatment option in non-muscle invasive bladder cancer (NMIBC) by reducing not only recurrence but also progression rates. However, the BCG response varies depending on many factors. In our study, besides clinicopathological factors; SII (Systemic immune-inflammation index), NLR (Neutrophil-lymphocyte ratio), PLR (Platelet-lymphocyte ratio) and LMR (Lymphocyte-monocyte ratio) values in predicting BCG response was examined. Between January 2010 and March 2023, 163 patients with NMIBC who were followed up by our clinic were included in the study. Demographic, clinical and pathological data of the patients, EAU risk group, pre-Tur-m NLR, PLR, LMR and SII values were analyzed. The patients were divided into two groups as BCG naive and refractory. Clinicopathological and inflammatory factors were compared between the groups. In addition, inflammatory parameters were compared by grouping them separately according to recurrence and progression. There was no significant difference between the groups in terms of gender, tumor stage and grade, multifocality , prostatic urethra and bladder neck involvement, histological subtype, and primary /recurrent disease. A higher rate of BCG refractory was observed in elderly patients (>65), those with a history of upper urinary tract tumor (UTUC), tumors with solid morphology and accompanying CIS , high-grade tumor in re- TURm , and patients in the high-risk group of EAU. SII, NLR, and PLR values were higher in the BCG refractory group than in BCG naive patients. SII cut The off value was determined as 561,9. CIS, UTUC history, solid tumor morphology, presence of high-grade tumor in re- TURm, high SII, NLR and PLR values may predict BCG response, recurrence and progression. In these patient groups, radical curative treatment options may be preferred rather than intravesical BCG treatment. Key words: Bladder Cancer, BCG Response, İnflammatory Factors, BCG Refractor
Açıklama
Tıp Fakültesi, Üroloji Ana Bilim Dalı
Anahtar Kelimeler
Üroloji, Urology
