Mesanenin Non- İnvaziv Papiller Ürotelyal Neoplazilerinde Rekürrens ve Progresyonu Öngörebilecek Klinik ve Histomorfolojik Parametrelerin Analizi

Abstract

Non-invasive papillary neoplasia of the urinary bladder (NIPUN) is a chronic disease with frequent recurrence and variable prognosis. Due to lifelong control regimens and repetitive treatments, it is the most expensive tumor per capita. The aim of this study is to establish clinical and pathological parameters that can predict recurrence and progression in NIPUN. 115 cases of NIPUN of which the primary diagnoses were given in the Pathology Department of Hacettepe University Hospital between the years 2000 ? 2010 with at least one year clinical follow-up were analysed. 7% of the cases were papillary urothelial neoplasia of low malignant potential, 71% were low grade non-invasive papillary urothelial carcinoma and 22% were high grade non-invasive papillary urothelial carcinoma. Tissue microarrays containing both tumor tissue and nontumoral mucosa from primary and recurrent lesions were prepared. The immunohistochemical expressions of PTEN, phos-Akt, phos-mTOR, phos-S6, phos-4E-BP1, p27, c-MYC, cyclin D1, cyclin D3, p53, p63, 34BE12, SK-20, SK-7, synaptophysin, chromogranin and Ki-67 were explored, and HER2 gene amplification and Chr17 aneuploidy were investigated by in-situ hybridisation on the cut-sections from microarrays. 49.6% of the cases showed recurrence and 12.17% had progression. Results of univariant analysis indicated that high Ki-67 proliferation index and high phos-mTOR were associated with progression. Male sex and tumor size larger than 27 mm were independent prognostic factors that correlated with the risk of recurrence. 2 or more mitoses per 10 HPFs had statistically significant relation with the risk of recurrence (p=0.024). As a conclusion, noting the size of tumor and mitotic count is important. Ki-67 and phos-mTOR are the immunohistochemical markers that can be useful to determine the group of cases that may progress.