Mesane tümörlü hastalarda immunoscore'un onkolojik sonuçları ve prognozu öngörmede belirteç olarak değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
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Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Mesane kanseri, üriner sistemin en sık görülen malignitesidir ve tüm kanserler içerisinde en sık tanı konulan dokuzuncu kanserdir. Mesane kanserlerinin %90'ından fazlası transizyonel hücreli ürotelyal karsinomdur. Vakaların %25' ine kasa invazif mesane kanseri tanısı konur. Mesane kanseri hastalarının kalan %75'i kasa invazif olmayan mesane kanseridir; bu hastalarda kanser mukoza (evre Ta, Karsinoma in Situ [CIS]) veya submukoza (evre T1) ile sınırlıdır. Kasa invaze olmayan mesane kanseri vakalarının yaklaşık %70' i tekrarlamaktadır ve %15 'inde de evre ve derece ilerlemektedir. Bu nedenle bu hastaların sıkı bir şekilde takip edilmeleri gerekmektedir, bu durum da mesane kanserini yönetilmesi en pahalı kanserlerden biri yapar. İmmünskor testi, kanser sınıflaması için standartlaştırılmış ilk immün tabanlı testtir. Bu test için, tümör merkezi ve invazif margin içindeki CD3 + T hücrelerinin ve CD8 + sitotoksik T hücrelerinin yoğunlukları, formalinle sabitlenmiş parafine gömülmüş doku kesitlerinde immunohistokimyasal yöntemlerle boyanarak değerlendirilir. İmmünskor testi ilk olarak kolon kanserinde kullanılmış ve prognozu TNM evrelemesinden daha iyi kestirebildiği gösterilmiştir. İmmünskor testinin kolon kanserinin yanı sıra pankreas, akciğer, karaciğer, deri, böbrek ve meme kanseri ile bazı kanserlerin beyin metastazlarıyla ilgili çalışmaları mevcuttur. Çalışmamızda mesane kanserleri hastalarda immünskorun tespit edilerek prognostik belirteç olarak kullanılıp kullanılamayacağını araştırmayı amaçladık. Çalışmamıza kliniğimizde 2009-2019 yılları arasında mesane kanseri nedeniyle tedavi edilen toplam 610 hasta dahil edildi. Hastalara dahil edilme ve dışlanma kriterleri uygulandıktan sonra kalan 405 hastanın pair matching yöntemiyle eşleştirilmesine karar verildi. Yaş (± 4), cinsiyet (erkek ve kadın), sigara içme durumu (eski içici ve aktif içici) ve hastalık evresine göre (Ta, T1, T2) hastalar eşleştirildi ve 23 pTa, 57 pT1, 57 pT2 ürotelyal karsinomlu toplam 137 hasta tespit edildi. Bu hastaların immünskorları tespit edilerek sonuçlar tümör boyutları, tümör sayıları, progresyon gibi bir çok parametre açısından karşılaştırıldı. Tespit ettiğimiz en önemli iki sonuçtan ilki CD3 immünskor ile Ta, T1 ve T2 hasta grupları arasında anlamlı farklılığın olmasıydı. Diğeri ise ekstravezikal hastalık açısından gruplar arasında immünskor bakımından anlamlı farklılık olmasıdır. Ekstravezikal hastalık olmayan hastaların çıkartılarak bu farkın ayrıntısı değerlendirildiğinde sadece uzak metastazı olan hasta grubunda, immünskor 0 ve 1 olarak tanımlanan yüksek riskli immünskor seviyeleri olan hastaların düşük riskli immünskor seviyeleri olanlardan fazla olduğu görülmüştür.
Bladder cancer is the most common malignancy of the urinary system. It is the ninth most frequently diagnosed cancer among all cancers. More than 90% of bladder cancers are transitional cell urothelial carcinoma. A total of 25% of the cases are diagnosed with muscle-invasive bladder cancer. The remaining 75% of bladder cancer patients are non-muscle invasive bladder cancer. In these patients, the tumor is limited to the mucosa (stage Ta, Carcinoma in Situ [CIS]) or submucosa (stage T1). Approximately 70% of non-muscle invasive bladder cancer cases recur, and 15% of them progress in stage and grade. Therefore, these patients need to be closely monitored, making bladder cancer one of the most expensive cancers to manage. The immunoscore test is the first standardized immuno-based test for cancer classification. For this test, the densities of CD3 + T cells and CD8 + cytotoxic T cells in the tumor center and the invasive margin are evaluated by immunohistochemical staining in formalin-fixed paraffin-embedded tissue sections. The immunoscore testing was first used in colon cancer, and it has been shown to predict the prognosis better than TNM staging. The immunoscore test has studies on pancreatic, lung, liver, skin, kidney, and breast cancer and brain metastases in some cancers in addition to colon cancer. Our study aimed to investigate whether immunscore test can be used in patients with bladder cancer as a prognostic marker. A total of 610 patients treated for bladder cancer in our clinic between 2009-2019 were included in our study. After the inclusion and exclusion criteria were applied to the patients, it was decided to match the remaining 405 patients using the pair matching method. Patients were matched by age (± 4), gender (male and female), smoking status (former smoker and active smoker), and disease stage (Ta, T1, T2), and a total of 137 patients with urothelial carcinoma 23 pTa, 57 pT1, 57 pT2 detected. Immunoscores of these patients were determined, and the results were compared in terms of many parameters, such as tumor size, tumor number, and progression. The first of the two most important results we detected was a significant difference between CD3 immunity and Ta, T1, and T2 patient groups. The other is that there is a significant difference between the groups in terms of extravesical disease in terms of immunscore. When the details of this difference were evaluated by excluding the patients without the extravesical disease, it was seen that only the patients with distant metastases had high-risk immunscore levels, defined as immunscore 0 and 1, higher than those with low-risk immunscore levels.
Bladder cancer is the most common malignancy of the urinary system. It is the ninth most frequently diagnosed cancer among all cancers. More than 90% of bladder cancers are transitional cell urothelial carcinoma. A total of 25% of the cases are diagnosed with muscle-invasive bladder cancer. The remaining 75% of bladder cancer patients are non-muscle invasive bladder cancer. In these patients, the tumor is limited to the mucosa (stage Ta, Carcinoma in Situ [CIS]) or submucosa (stage T1). Approximately 70% of non-muscle invasive bladder cancer cases recur, and 15% of them progress in stage and grade. Therefore, these patients need to be closely monitored, making bladder cancer one of the most expensive cancers to manage. The immunoscore test is the first standardized immuno-based test for cancer classification. For this test, the densities of CD3 + T cells and CD8 + cytotoxic T cells in the tumor center and the invasive margin are evaluated by immunohistochemical staining in formalin-fixed paraffin-embedded tissue sections. The immunoscore testing was first used in colon cancer, and it has been shown to predict the prognosis better than TNM staging. The immunoscore test has studies on pancreatic, lung, liver, skin, kidney, and breast cancer and brain metastases in some cancers in addition to colon cancer. Our study aimed to investigate whether immunscore test can be used in patients with bladder cancer as a prognostic marker. A total of 610 patients treated for bladder cancer in our clinic between 2009-2019 were included in our study. After the inclusion and exclusion criteria were applied to the patients, it was decided to match the remaining 405 patients using the pair matching method. Patients were matched by age (± 4), gender (male and female), smoking status (former smoker and active smoker), and disease stage (Ta, T1, T2), and a total of 137 patients with urothelial carcinoma 23 pTa, 57 pT1, 57 pT2 detected. Immunoscores of these patients were determined, and the results were compared in terms of many parameters, such as tumor size, tumor number, and progression. The first of the two most important results we detected was a significant difference between CD3 immunity and Ta, T1, and T2 patient groups. The other is that there is a significant difference between the groups in terms of extravesical disease in terms of immunscore. When the details of this difference were evaluated by excluding the patients without the extravesical disease, it was seen that only the patients with distant metastases had high-risk immunscore levels, defined as immunscore 0 and 1, higher than those with low-risk immunscore levels.
Açıklama
Anahtar Kelimeler
Mesane Hastalıkları, Urinary Bladder Diseases, Mesane Neoplazmları, Urinary Bladder Neoplasms, Neoplazmlar, Neoplasms, Prognoz, Prognosis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Aydoğan, M. F. (2020). Mesane tümörlü hastalarda immunoscore'un onkolojik sonuçları ve prognozu öngörmede belirteç olarak değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
