Kasa İnvaze Mesane Kanserine Yaklaşım
Özet
Kasa invaze mesane kanserine (KİMK) yönelik epidemiyoloji, etiyoloji, tanı, evreleme ve tedavi yaklaşımları bu çalışmada kapsamlı bir şekilde incelenmektedir. Erkeklerde daha sık görülen mesane kanserinin en önemli risk faktörü tütün kullanımı olup, mesleki kimyasal maruziyeti ve genetik etkenler de etiyolojide önemli rol oynar. Tanı aşamasında ağrısız makroskopik hematüri en sık başvuru semptomudur; kesin tanı ve evreleme için transüretral rezeksiyon (TUR-T) ile kas tabakasını içeren doku örneği alınması kritiktir. Evrelemede klinik performansları yüksek olan mpMRG (VI-RADS) ve BT gibi ileri görüntüleme yöntemlerinden yararlanılır. Lokalize KİMK yönetiminde altın standart tedavi, neoadjuvan sisplatin bazlı kemoterapiyi takiben uygulanan radikal sistektomi ve üriner diversiyondur. Cerrahi sınır, lenf nodu diseksiyonunun genişliği ve çıkartılan lenf nodu sayısı sağkalımı doğrudan etkilemektedir. Uygun hastalarda veya cerrahiye elverişli olmayan olgularda, mesane koruyucu bir yaklaşım olarak TUR-T, kemoterapi ve radyoterapi kombinasyonundan oluşan trimodal tedavi (TMT) etkin bir alternatif sunar. Postoperatif dönemde patolojik yüksek riskli hastalar için adjuvan platin bazlı kemoterapi ve nivolumab gibi immunoterapiler nüks riskini azaltmada güncel seçeneklerdir. Sonuç olarak, KİMK'nin agresif doğası gereği ürolog, medikal onkolog ve radyasyon onkoloğunun iş birliğini içeren multidisipliner bir yaklaşım şarttır.
Epidemiology, etiology, diagnosis, staging, and treatment approaches for muscle-invasive bladder cancer (MIBC) are comprehensively examined in this study. Bladder cancer, which is more prevalent in men, has tobacco use as its primary risk factor, while occupational chemical exposure and genetic factors also play important roles in its etiology. Painless macroscopic hematuria is the most common presenting symptom during the diagnostic phase; obtaining a tissue sample that includes the muscle layer via transurethral resection (TUR-T) is critical for definitive diagnosis and staging. Advanced imaging modalities with high clinical performance, such as mpMRI (VI-RADS) and CT, are utilized for staging. The gold standard treatment in localized MIBC management is radical cystectomy and urinary diversion following neoadjuvant cisplatin-based chemotherapy. Surgical margins, the extent of lymph node dissection, and the number of removed lymph nodes directly impact survival. In eligible patients or those unfit for surgery, trimodal therapy (TMT)—consisting of a combination of TUR-T, chemotherapy, and radiotherapy—offers an effective bladder-preserving alternative. Postoperatively, adjuvant platinum-based chemotherapy and immunotherapies like nivolumab are current options to reduce recurrence risk for pathologically high-risk patients. Consequently, due to the aggressive nature of MIBC, a multidisciplinary approach involving the collaboration of a urologist, medical oncologist, and radiation oncologist is mandatory.
Referanslar
Rl S, KD M, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1): 7–30.
Babjuk M, Burger M, Capoun O, et al. European Association of Urology guidelines on non–muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). European urology. Elsevier; 2021;
Witjes JA, Bruins HM, Cathomas R, et al. European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. European urology. Elsevier; 2021;79(1): 82–104.
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. Wiley Online Library; 2021;71(3): 209–249.
Burger M, Catto JW, Dalbagni G, et al. Epidemiology and risk factors of urothelial bladder cancer. European urology. Elsevier; 2013;63(2): 234–241.
van Osch FH, Jochems SH, van Schooten F-J, et al. Quantified relations between exposure to tobacco smoking and bladder cancer risk: a meta-analysis of 89 observational studies. International journal of epidemiology. Oxford University Press; 2016;45(3): 857–870.
Brennan P, Bogillot O, Cordier S, et al. Cigarette smoking and bladder cancer in men: A pooled analysis of 11 case‐control studies. International journal of cancer. Wiley Online Library; 2000;86(2): 289–294.
Gandini S, Botteri E, Iodice S, et al. Tobacco smoking and cancer: a meta‐analysis. International journal of cancer. Wiley Online Library; 2008;122(1): 155–164.
Al Hussein Al Awamlh B, Shoag JE, Ravikumar V, et al. Association of smoking and death from genitourinary malignancies: analysis of the National Longitudinal Mortality Study. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2019;202(6): 1248–1254.
Freedman ND, Silverman DT, Hollenbeck AR, et al. Association between smoking and risk of bladder cancer among men and women. Jama. American Medical Association; 2011;306(7): 737–745.
Zhang Y, Birmann BM, Han J, et al. Personal use of permanent hair dyes and cancer risk and mortality in US women: prospective cohort study. bmj. British Medical Journal Publishing Group; 2020;370.
Pashos CL, Botteman MF, Laskin BL, et al. Bladder cancer: epidemiology, diagnosis, and management. Cancer practice. Wiley Online Library; 2002;10(6): 311–322.
Weistenhöfer W, Blaszkewicz M, Bolt HM, et al. N-acetyltransferase-2 and medical history in bladder cancer cases with a suspected occupational disease (BK 1301) in Germany. Journal of Toxicology and Environmental Health, Part A. Taylor & Francis; 2008;71(13–14): 906–910.
Chrouser K, Leibovich B, Bergstralh E, et al. Bladder cancer risk following primary and adjuvant external beam radiation for prostate cancer. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2005;174(1): 107–110.
Nieder AM, Porter MP, Soloway MS. Radiation therapy for prostate cancer increases subsequent risk of bladder and rectal cancer: a population based cohort study. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2008;180(5): 2005–2010.
Zamora-Ros R, Sacerdote C, Ricceri F, et al. Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. British journal of cancer. Nature Publishing Group; 2014;111(9): 1870–1880.
Teleka S, Häggström C, Nagel G, et al. Risk of bladder cancer by disease severity in relation to metabolic factors and smoking: a prospective pooled cohort study of 800,000 men and women. International journal of cancer. Wiley Online Library; 2018;143(12): 3071–3082.
Xu Y, Huo R, Chen X, et al. Diabetes mellitus and the risk of bladder cancer: a PRISMA-compliant meta-analysis of cohort studies. Medicine. Wolters Kluwer Health; 2017;96(46).
Adil M, Khan RA, Ghosh P, et al. Pioglitazone and risk of bladder cancer in type 2 diabetes mellitus patients: A systematic literature review and meta-analysis of observational studies using real-world data. Clinical Epidemiology and Global Health. Elsevier; 2018;6(2): 61–68.
Salem HK, Mahfouz S. Changing patterns (age, incidence, and pathologic types) of schistosoma-associated bladder cancer in Egypt in the past decade. Urology. Elsevier; 2012;79(2): 379–383.
Pelucchi C, Bosetti C, Negri E, et al. Mechanisms of disease: the epidemiology of bladder cancer. Nature Clinical Practice Urology. Nature Publishing Group; 2006;3(6): 327–340.
Yu Z, Yue W, Jiuzhi L, et al. The risk of bladder cancer in patients with urinary calculi: a meta-analysis. Urolithiasis. Springer; 2018;46(6): 573–579.
Liu S, Yang T, Na R, et al. The impact of female gender on bladder cancer-specific death risk after radical cystectomy: a meta-analysis of 27,912 patients. International Urology and Nephrology. Springer; 2015;47(6): 951–958.
Cohn JA, Vekhter B, Lyttle C, et al. Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: a nationwide claims‐based investigation. Cancer. Wiley Online Library; 2014;120(4): 555–561.
Martin C, Leiser CL, O’Neil B, et al. Familial cancer clustering in urothelial cancer: a population-based case–control study. JNCI: Journal of the National Cancer Institute. Oxford University Press; 2018;110(5): 527–533.
Park S, Reuter VE, Hansel DE. Non‐urothelial carcinomas of the bladder. Histopathology. Wiley Online Library; 2019;74(1): 97–111.
Veskimäe E, Espinos EL, Bruins HM, et al. What is the prognostic and clinical importance of urothelial and nonurothelial histological variants of bladder cancer in predicting oncological outcomes in patients with muscle-invasive and metastatic bladder cancer? A European association of urology muscle invasive and metastatic bladder cancer guidelines panel systematic review. European urology oncology. Elsevier; 2019;2(6): 625–642.
Wijkström H, Norming U, Lagerkvist M, et al. Evaluation of clinical staging before cystectomy in transitional cell bladder carcinoma: a long-term follow-up of 276 consecutive patients. British journal of urology. 1998;81(5): 686–691.
Lokeshwar VB, Habuchi T, Grossman HB, et al. Bladder tumor markers beyond cytology: International Consensus Panel on bladder tumor markers. Urology. Elsevier; 2005;66(6): 35–63.
Van Rhijn BW, Van der Poel HG, van Der Kwast TH. Urine markers for bladder cancer surveillance: a systematic review. European urology. Elsevier; 2005;47(6): 736–748.
Weiner AB, Desai AS, Meeks JJ. Tumor location may predict adverse pathology and survival following definitive treatment for bladder cancer: a national cohort study. European Urology Oncology. Elsevier; 2019;2(3): 304–310.
von Rundstedt F-C, Mata DA, Shen S, et al. Transurethral biopsy of the prostatic urethra is associated with final apical margin status at radical cystoprostatectomy. Journal of clinical urology. SAGE Publications Sage UK: London, England; 2016;9(6): 404–408.
Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. John Wiley & Sons; 2017.
Compérat EM, Burger M, Gontero P, et al. Grading of urothelial carcinoma and the new “World Health Organisation classification of tumours of the urinary system and male genital organs 2016”. European urology focus. Elsevier; 2019;5(3): 457–466.
Panebianco V, Narumi Y, Altun E, et al. Multiparametric magnetic resonance imaging for bladder cancer: development of VI-RADS (Vesical Imaging-Reporting And Data System). European urology. Elsevier; 2018;74(3): 294–306.
Woo S, Panebianco V, Narumi Y, et al. Diagnostic performance of vesical imaging reporting and data system for the prediction of muscle-invasive bladder cancer: a systematic review and meta-analysis. European urology oncology. Elsevier; 2020;3(3): 306–315.
Kundra V, Silverman PM. Imaging in the diagnosis, staging, and follow-up of cancer of the urinary bladder. American Journal of Roentgenology. American Roentgen Ray Society; 2003;180(4): 1045–1054.
PAIK ML, SCOLIERI MJ, Brown SL, et al. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2000;163(6): 1693–1696.
Yang WT, Lam WWM, Yu MY, et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. American Journal of Roentgenology. Am Roentgen Ray Soc; 2000;175(3): 759–766.
Barentsz J, Engelbrecht M, Witjes J, et al. MR imaging of the male pelvis. European radiology. Springer; 1999;9(9): 1722–1736.
Dorfman RE, Alpern MB, Gross B, et al. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology. 1991;180(2): 319–322.
Vind-Kezunovic S, Bouchelouche K, Ipsen P, et al. Detection of lymph node metastasis in patients with bladder cancer using maximum standardised uptake value and 18F-fluorodeoxyglucose positron emission tomography/computed tomography: results from a high-volume centre including long-term follow-up. European urology focus. Elsevier; 2019;5(1): 90–96.
Cowan NC, Turney BW, Taylor NJ, et al. Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU international. Wiley Online Library; 2007;99(6): 1363–1370.
Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2010;183(4): 1330–1336.
Heidenreich A, Albers P, Classen J, et al. Imaging studies in metastatic urogenital cancer patients undergoing systemic therapy: recommendations of a multidisciplinary consensus meeting of the Association of Urological Oncology of the German Cancer Society. Urologia internationalis. Karger Publishers; 2010;85(1): 1–10.
Braendengen M, Winderen M, Fosså S. Clinical significance of routine pre‐cystectomy bone scans in patients with muscle‐invasive bladder cancer. British journal of urology. Wiley Online Library; 1996;77(1): 36–40.
Lauenstein TC, Goehde SC, Herborn CU, et al. Whole-body MR imaging: evaluation of patients for metastases. Radiology. Radiological Society of North America; 2004;233(1): 139–148.
Yang Z, Cheng J, Pan L, et al. Is whole-body fluorine-18 fluorodeoxyglucose PET/CT plus additional pelvic images (oral hydration–voiding–refilling) useful for detecting recurrent bladder cancer? Annals of nuclear medicine. Springer; 2012;26(7): 571–577.
Bryan RT, Liu W, Pirrie SJ, et al. Comparing an imaging-guided pathway with the standard pathway for staging muscle-invasive bladder cancer: preliminary data from the BladderPath study. European urology. Elsevier; 2021;80(1): 12–15.
Porter MP, Kerrigan MC, Donato BM, et al. Patterns of use of systemic chemotherapy for Medicare beneficiaries with urothelial bladder cancer. Elsevier; 2011. p. 252–258.
Nguyen DP, Thalmann GN. Contemporary update on neoadjuvant therapy for bladder cancer. Nature Reviews Urology. Nature Publishing Group; 2017;14(6): 348–358.
Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. New England Journal of Medicine. Mass Medical Soc; 2003;349(9): 859–866.
Plimack ER, Hoffman-Censits JH, Viterbo R, et al. Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin is safe, effective, and efficient neoadjuvant treatment for muscle-invasive bladder cancer: results of a multicenter phase II study with molecular correlates of response and toxicity. Journal of clinical oncology. American Society of Clinical Oncology; 2014;32(18): 1895.
von der Maase H, Hansen S, Roberts J, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. Journal of clinical oncology. American Society of Clinical Oncology; 2000;18(17): 3068–3077.
Galsky MD, Hahn NM, Rosenberg J, et al. Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. Journal of clinical oncology. American Society of Clinical Oncology; 2011;29(17): 2432–2438.
Galsky M, Chen G, Oh W, et al. Comparative effectiveness of cisplatin-based and carboplatin-based chemotherapy for treatment of advanced urothelial carcinoma. Annals of oncology. Elsevier; 2012;23(2): 406–410.
Powles T, Kockx M, Rodriguez-Vida A, et al. Clinical efficacy and biomarker analysis of neoadjuvant atezolizumab in operable urothelial carcinoma in the ABACUS trial. Nature medicine. Nature Publishing Group; 2019;25(11): 1706–1714.
Necchi A, Anichini A, Raggi D, et al. Pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive urothelial bladder carcinoma (PURE-01): an open-label, single-arm, phase II study. Journal of Clinical Oncology. American Society of Clinical Oncology; 2018;36(34): 3353–3360.
Rose TL, Harrison MR, Deal AM, et al. Phase II study of gemcitabine and split-dose cisplatin plus pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive bladder cancer. Journal of Clinical Oncology. Wolters Kluwer; 2021;39(28): 3140–3148.
Zaghloul MS, Christodouleas JP, Smith A, et al. Adjuvant sandwich chemotherapy plus radiotherapy vs adjuvant chemotherapy alone for locally advanced bladder cancer after radical cystectomy: a randomized phase 2 trial. JAMA surgery. American Medical Association; 2018;153(1): e174591–e174591.
Iwata T, Kimura S, Abufaraj M, et al. The role of adjuvant radiotherapy after surgery for upper and lower urinary tract urothelial carcinoma: a systematic review. Elsevier; 2019. p. 659–671.
Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. Journal of clinical oncology. American Society of Clinical Oncology; 2001;19(3): 666–675.
Hernandez V, Espinos EL, Dunn J, et al. Oncological and functional outcomes of sexual function–preserving cystectomy compared with standard radical cystectomy in men: a systematic review. Elsevier; 2017. p. 539-e17.
Voigt M, Hemal K, Matthews C. Influence of simple and radical cystectomy on sexual function and pelvic organ prolapse in female patients: a scoping review of the literature. Sexual Medicine Reviews. Elsevier; 2019;7(3): 408–415.
Veskimäe E, Neuzillet Y, Rouanne M, et al. Systematic review of the oncological and functional outcomes of pelvic organ‐preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. BJU international. Wiley Online Library; 2017;120(1): 12–24.
Russell B, Liedberg F, Khan MS, et al. A systematic review and meta-analysis of delay in radical cystectomy and the effect on survival in bladder cancer patients. European Urology Oncology. Elsevier; 2020;3(2): 239–249.
Wallmeroth A, Wagner U, Moch H, et al. Patterns of metastasis in muscle-invasive bladder cancer (pT2–4): an autopsy study on 367 patients. Urologia Internationalis. Karger Publishers; 1999;62(2): 69–75.
Simone G, Papalia R, Ferriero M, et al. Stage‐specific impact of extended versus standard pelvic lymph node dissection in radical cystectomy. International journal of urology. Wiley Online Library; 2013;20(4): 390–397.
Zehnder P, Studer UE, Skinner EC, et al. Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2011;186(4): 1261–1268.
Wright JL, Lin DW, Porter MP. The association between extent of lymphadenectomy and survival among patients with lymph node metastases undergoing radical cystectomy. Cancer: Interdisciplinary International Journal of the American Cancer Society. Wiley Online Library; 2008;112(11): 2401–2408.
Stenzl A. Bladder substitution. Current Opinion in Urology. LWW; 1999;9(3): 241–245.
Roth B, Furrer MA, Giannakis I, et al. Positive pre-cystectomy biopsies of the prostatic urethra or bladder neck do not necessarily preclude orthotopic bladder substitution. The journal of urology. Wolters Kluwer Philadelphia, PA; 2019;201(5): 909–915.
Hautmann RE, Volkmer BG, Schumacher MC, et al. Long-term results of standard procedures in urology: the ileal neobladder. World journal of urology. Springer; 2006;24(3): 305–314.
Herr HW. Conservative management of muscle-infiltrating bladder cancer: prospective experience. The Journal of urology. Elsevier; 1987;138(5): 1162–1163.
Solsona E, Iborra I, Collado A, et al. Feasibility of radical transurethral resection as monotherapy for selected patients with muscle invasive bladder cancer. The Journal of urology. Wolters Kluwer Philadelphia, PA; 2010;184(2): 475–481.
Choudhury A, Porta N, Hall E, et al. Hypofractionated radiotherapy in locally advanced bladder cancer: an individual patient data meta-analysis of the BC2001 and BCON trials. The Lancet Oncology. Elsevier; 2021;22(2): 246–255.
Korpics MC, Block AM, Martin B, et al. Concurrent chemotherapy is associated with improved survival in elderly patients with bladder cancer undergoing radiotherapy. Cancer. Wiley Online Library; 2017;123(18): 3524–3531.
Herr HW, Bajorin DF, Scher HI. Neoadjuvant chemotherapy and bladder-sparing surgery for invasive bladder cancer: ten-year outcome. Journal of clinical oncology. 1998;16(4): 1298–1301.
Audenet F, Waingankar N, Ferket BS, et al. Effectiveness of transurethral resection plus systemic chemotherapy as definitive treatment for muscle invasive bladder cancer in population level data. The Journal of Urology. Elsevier; 2018;200(5): 996–1004.
Merten R, Ott O, Haderlein M, et al. Long‐term experience of chemoradiotherapy combined with deep regional hyperthermia for organ preservation in high‐risk bladder cancer (Ta, Tis, T1, T2). The oncologist. Oxford University Press; 2019;24(12): e1341–e1350.
Giacalone NJ, Shipley WU, Clayman RH, et al. Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer: an updated analysis of the Massachusetts General Hospital experience. European urology. Elsevier; 2017;71(6): 952–960.
Suer E, Hamidi N, Gokce MI, et al. Significance of second transurethral resection on patient outcomes in muscle-invasive bladder cancer patients treated with bladder-preserving multimodal therapy. World journal of urology. Springer; 2016;34(6): 847–851.
James ND, Hussain SA, Hall E, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. New England Journal of Medicine. Mass Medical Soc; 2012;366(16): 1477–1488.
Kulkarni GS, Hermanns T, Wei Y, et al. Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic. Journal of clinical oncology. American Society of Clinical Oncology; 2017;35(20): 2299–2305.
Ploussard G, Daneshmand S, Efstathiou JA, et al. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. European urology. Elsevier; 2014;66(1): 120–137.
Donat SM, Shabsigh A, Savage C, et al. Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume tertiary cancer center experience. European urology. Elsevier; 2009;55(1): 177–186.
Svatek RS, Shariat SF, Lasky RE, et al. The Effectiveness of Off-Protocol Adjuvant Chemotherapy for Patients with Urothelial Carcinoma of the Urinary BladderOff-Protocol Adjuvant Chemotherapy for Bladder Cancer. Clinical Cancer Research. AACR; 2010;16(17): 4461–4467.
Galsky MD, Stensland KD, Moshier E, et al. Effectiveness of adjuvant chemotherapy for locally advanced bladder cancer. Journal of Clinical Oncology. American Society of Clinical Oncology; 2016;34(8): 825–832.
Berg S, D’Andrea D, Vetterlein MW, et al. Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle‐invasive carcinoma of the bladder: Does histologic subtype matter? Cancer. Wiley Online Library; 2019;125(9): 1449–1458.
Bajorin DF, Witjes JA, Gschwend JE, et al. Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma. New England Journal of Medicine. Mass Medical Soc; 2021;384(22): 2102–2114.
