.: ORİJİNAL ARAŞTIRMA
Antikoagülan/Antiagregan İlaç Kullanımının Mesane Kanserinin Primer Tanı Evresine Etkisi: Retrospektif Kesitsel Çalışma
The Effect of Anticoagulant/Antiagregan Drug Usage on the Primary Diagnosis Stage of Bladder Cancer: A Retrospective Cross-sectional Study
J Reconstr Urol. 2023;13(2):47-52
doi: 10.5336/urology.2023-95961
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Bu çalışmada, makroskobik hematüri sonrası primer mesane kanseri tespit edilen hastalarda antikoagülan ve/veya antiagregan ilaç kullanımının hastalığın teşhisindeki evresine olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışma retrospektif olarak makroskobik hematüri gelişimi sonrasında primer mesane kanseri tespit edilen hastalar arasında yapıldı. Hastaların yaş, cinsiyet, sigara kullanımı, Amerikan Anesteziyoloji Derneği skoru kaydedildi. Nonürotelyal mesane kanseri olanlar, pür karsinoma in situ olarak raporlanan olgular, komşu organ invazyonu olarak patolojik tanı alan hastalar dâhil edilmedi. Hastaların tümör sayısı, boyutu, T evresi ve tümör derecesi kaydedildi. Hastaların Avrupa Üroloji Derneği mesane kanseri risk gruplandırması (düşük, orta veya yüksek) kaydedildi. Hastalar antikoagülan ve/veya antiagregan tedavi (AAT) kullanım durumuna göre AAT (+) ve AAT (-) olarak 2 gruba ayrıldı. 'Her iki grubun sosyodemografik ve histopatolojik özellikleri karşılaştırmalı olarak analiz edildi. Bulgular: Çalışmaya retrospektif olarak taranan ve kriterlere uyan 153 hasta dâhil edildi. Hastaların ortalama yaşı 64,69±12,25 idi. Hastalardan 54'ünün (%35,2) AAT (+) ve 99'unun (%64,8) AAT (-) grupta olduğu hesaplandı. Her iki grubun analizinde yaş, cinsiyet, tümör sayısı açısından anlamlı fark olmadığı görüldü (p>0,05). Tümör boyutu <3 cm (%75,9'a karşı %62,6; p=0,091) olan hastaların oranı AAT (+) grubunda daha fazla olsa da anlamlı fark izlenmedi. Kas invaziv hastalık oranı (≥T2) (%17,1'e karşı %3,7; p=0,015) ve yüksek dereceli mesane kanseri oranının (%46,4'e karşı %27,7; p=0,024) AAT (-) grupta istatistiksel anlamlı olarak daha fazla olduğu hesaplandı. Rekürrens risk skorlamasına göre Avrupa Kanser Araştırma ve Tedavi Organizasyonu ≤5 olan (%66,6'ya karşı %45,4; p=0,012) hastaların AAT (+) grupta daha fazla olduğu görüldü. Sonuç: Bu çalışmada, makroskobik hematüri ile tanı alan primer mesane kanserinde AAT kullanımının hastalığın daha düşük evre ve derecede saptanması ile ilişkili olduğu sonucuna varıldı.
Anahtar Kelimeler: Mesane kanseri; makroskobik hematüri; antiagregan ilaçlar; antikoagülan ilaçlar
Amaç: Bu çalışmada, makroskobik hematüri sonrası primer mesane kanseri tespit edilen hastalarda antikoagülan ve/veya antiagregan ilaç kullanımının hastalığın teşhisindeki evresine olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışma retrospektif olarak makroskobik hematüri gelişimi sonrasında primer mesane kanseri tespit edilen hastalar arasında yapıldı. Hastaların yaş, cinsiyet, sigara kullanımı, Amerikan Anesteziyoloji Derneği skoru kaydedildi. Nonürotelyal mesane kanseri olanlar, pür karsinoma in situ olarak raporlanan olgular, komşu organ invazyonu olarak patolojik tanı alan hastalar dâhil edilmedi. Hastaların tümör sayısı, boyutu, T evresi ve tümör derecesi kaydedildi. Hastaların Avrupa Üroloji Derneği mesane kanseri risk gruplandırması (düşük, orta veya yüksek) kaydedildi. Hastalar antikoagülan ve/veya antiagregan tedavi (AAT) kullanım durumuna göre AAT (+) ve AAT (-) olarak 2 gruba ayrıldı. 'Her iki grubun sosyodemografik ve histopatolojik özellikleri karşılaştırmalı olarak analiz edildi. Bulgular: Çalışmaya retrospektif olarak taranan ve kriterlere uyan 153 hasta dâhil edildi. Hastaların ortalama yaşı 64,69±12,25 idi. Hastalardan 54'ünün (%35,2) AAT (+) ve 99'unun (%64,8) AAT (-) grupta olduğu hesaplandı. Her iki grubun analizinde yaş, cinsiyet, tümör sayısı açısından anlamlı fark olmadığı görüldü (p>0,05). Tümör boyutu <3 cm (%75,9'a karşı %62,6; p=0,091) olan hastaların oranı AAT (+) grubunda daha fazla olsa da anlamlı fark izlenmedi. Kas invaziv hastalık oranı (≥T2) (%17,1'e karşı %3,7; p=0,015) ve yüksek dereceli mesane kanseri oranının (%46,4'e karşı %27,7; p=0,024) AAT (-) grupta istatistiksel anlamlı olarak daha fazla olduğu hesaplandı. Rekürrens risk skorlamasına göre Avrupa Kanser Araştırma ve Tedavi Organizasyonu ≤5 olan (%66,6'ya karşı %45,4; p=0,012) hastaların AAT (+) grupta daha fazla olduğu görüldü. Sonuç: Bu çalışmada, makroskobik hematüri ile tanı alan primer mesane kanserinde AAT kullanımının hastalığın daha düşük evre ve derecede saptanması ile ilişkili olduğu sonucuna varıldı.
Anahtar Kelimeler: Mesane kanseri; makroskobik hematüri; antiagregan ilaçlar; antikoagülan ilaçlar
ABSTRACT
Objective: We aimed to investigate the effect of anticoagulant and/or anti-aggregant drug use on the stage of diagnosis of the disease in patients with primary bladder cancer after macroscopic hematuria. Material and Methods: The study was conducted retrospectively among patients with primary bladder cancer after the development of macroscopic hematuria. Age, gender, smoking, American Society of Anesthesiology scores of the patients were recorded. Patients with nonurothelial bladder cancer, carcinoma in-situ, and adjacent organ invasion were not included. The tumor number, size, T stage and tumor grade of the patients were recorded. European Association of Urology bladder cancer risk group (low, moderate, or high) were recorded. The patients were divided into two groups as AAT (+) and AAT (-) according to their use of anticoagulant and/or anti-aggregant therapy (AAT). Sociodemographic characteristics, histopathological characteristics of the both groups were analyzed comparatively. Results: A total of 153 patients who were retrospectively screened and met the criteria were included in the study. The mean age of the patients was 64.69±12.25. It was calculated that 54 (35.2%) of the patients were in the AAT (+) and 99 (64.8%) patients were in the AAT (-) group. There was no significant difference in terms of age, gender and tumor number (p>0.05). Although the proportion of patients with tumor size T2) (17.1% vs 3.7%; p=0.015) and high-grade bladder cancer rate (46.4% vs. 27.7%; p=0.024) were calculated to be higher in the AAT (-) group. According to the recurrence risk score, patients with a European Cancer Research and Treatment Organization score of ≤5 (66.6% vs. 45.4%; p=0.012) were found to be more common in the AAT (+) group. Conclusion: It was concluded that the use of AAT provoked the development of macroscopic hematuria and enabled the detection of bladder cancer at an earlier stage.
Keywords: Bladder cancer; macroscopic hematuria; antiaggregant drugs; anticoagulant drugs
Objective: We aimed to investigate the effect of anticoagulant and/or anti-aggregant drug use on the stage of diagnosis of the disease in patients with primary bladder cancer after macroscopic hematuria. Material and Methods: The study was conducted retrospectively among patients with primary bladder cancer after the development of macroscopic hematuria. Age, gender, smoking, American Society of Anesthesiology scores of the patients were recorded. Patients with nonurothelial bladder cancer, carcinoma in-situ, and adjacent organ invasion were not included. The tumor number, size, T stage and tumor grade of the patients were recorded. European Association of Urology bladder cancer risk group (low, moderate, or high) were recorded. The patients were divided into two groups as AAT (+) and AAT (-) according to their use of anticoagulant and/or anti-aggregant therapy (AAT). Sociodemographic characteristics, histopathological characteristics of the both groups were analyzed comparatively. Results: A total of 153 patients who were retrospectively screened and met the criteria were included in the study. The mean age of the patients was 64.69±12.25. It was calculated that 54 (35.2%) of the patients were in the AAT (+) and 99 (64.8%) patients were in the AAT (-) group. There was no significant difference in terms of age, gender and tumor number (p>0.05). Although the proportion of patients with tumor size T2) (17.1% vs 3.7%; p=0.015) and high-grade bladder cancer rate (46.4% vs. 27.7%; p=0.024) were calculated to be higher in the AAT (-) group. According to the recurrence risk score, patients with a European Cancer Research and Treatment Organization score of ≤5 (66.6% vs. 45.4%; p=0.012) were found to be more common in the AAT (+) group. Conclusion: It was concluded that the use of AAT provoked the development of macroscopic hematuria and enabled the detection of bladder cancer at an earlier stage.
Keywords: Bladder cancer; macroscopic hematuria; antiaggregant drugs; anticoagulant drugs
REFERANSLAR:
- Witjes JA, Bruins HM, Cathomas R, Compérat EM, Cowan NC, Gakis G, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines. Eur Urol. 2021;79(1):82-104. [Crossref] [PubMed]
- Kirkali Z, Chan T, Manoharan M, Algaba F, Busch C, Cheng L, et al. Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology. 2005;66(6 Suppl 1):4-34. [Crossref] [PubMed]
- Anastasiadis A, de Reijke TM. Best practice in the treatment of nonmuscle invasive bladder cancer. Ther Adv Urol. 2012;4(1):13-32. [Crossref] [PubMed] [PMC]
- Mi-ana B, Cózar JM, Palou J, Unda Urzaiz M, Medina-Lopez RA, Subirá Ríos J, et al. Bladder cancer in Spain 2011: population based study. J Urol. 2014;191(2):323-8. [Crossref] [PubMed]
- Hirsh J. Oral anticoagulant drugs. N Engl J Med. 1991;324(26):1865-75. [Crossref] [PubMed]
- Blankenship JC. Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors. Am Heart J. 1999;138(4 Pt 2):287-96. [Crossref] [PubMed]
- Avidor Y, Nadu A, Matzkin H. Clinical significance of gross hematuria and its evaluation in patients receiving anticoagulant and aspirin treatment. Urology. 2000;55(1):22-4. [Crossref] [PubMed]
- Lotan Y, Kamat AM, Porter MP, Robinson VL, Shore N, Jewett M, et al; Bladder Cancer Think Tank; Bladder Cancer Advocacy Network; Society of Urologic Oncology. Key concerns about the current state of bladder cancer: a position paper from the Bladder Cancer Think Tank, the Bladder Cancer Advocacy Network, and the Society of Urologic Oncology. Cancer. 2009;115(18):4096-103. [Crossref] [PubMed]
- Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108. [Crossref] [PubMed]
- Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19(3):666-75. [Crossref] [PubMed]
- Yafi FA, Aprikian AG, Chin JL, Fradet Y, Izawa J, Estey E, et al. Contemporary outcomes of 2287 patients with bladder cancer who were treated with radical cystectomy: a Canadian multicentre experience. BJU Int. 2011;108(4):539-45. [Crossref] [PubMed]
- Knowles MA, Hurst CD. Molecular biology of bladder cancer: new insights into pathogenesis and clinical diversity. Nat Rev Cancer. 2015;15(1):25-41. [Crossref] [PubMed]
- Moschini M, Karnes RJ, Suardi N, Bianchi M, Pellucchi F, Rocchini L, et al. Potential effect of antiplatelet and anticoagulant therapy on the timing of the diagnosis of bladder cancer. Clin Genitourin Cancer. 2016;14(3):e245-50. [Crossref] [PubMed]
- Mariani AJ, Mariani MC, Macchioni C, Stams UK, Hariharan A, Moriera A. The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis. J Urol. 1989;141(2):350-5. [Crossref] [PubMed]
- Khadra MH, Pickard RS, Charlton M, Powell PH, Neal DE. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol. 2000;163(2):524-7. [Crossref] [PubMed]
- Sutton JM. Evaluation of hematuria in adults. JAMA. 1990;263(18):2475-80. [Crossref] [PubMed]
- Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, et al; British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol. 2011;154(3):311-24. [Crossref] [PubMed]
- Serebruany VL, Malinin AI, Eisert RM, Sane DC. Risk of bleeding complications with antiplatelet agents: meta-analysis of 338,191 patients enrolled in 50 randomized controlled trials. Am J Hematol. 2004;75(1):40-7. [Crossref] [PubMed]
- Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54(23):2205-41. Erratum in: J Am Coll Cardiol. 2009;54(25):2464. Erratum in: J Am Coll Cardiol. 2010;55(6):612. Dosage error in article text. [PubMed]
- Loewen P, Dahri K. Risk of bleeding with oral anticoagulants: an updated systematic review and performance analysis of clinical prediction rules. Ann Hematol. 2011;90(10):1191-200. [Crossref] [PubMed]
- Culclasure TF, Bray VJ, Hasbargen JA. The significance of hematuria in the anticoagulated patient. Arch Intern Med. 1994;154(6):649-52. [Crossref] [PubMed]
- Shinagare AB, Silverman SG, Gershanik EF, Chang SL, Khorasani R. Evaluating hematuria: impact of guideline adherence on urologic cancer diagnosis. Am J Med. 2014;127(7):625-32. [Crossref] [PubMed]
- Nieder AM, Lotan Y, Nuss GR, Langston JP, Vyas S, Manoharan M, et al. Are patients with hematuria appropriately referred to Urology? A multi-institutional questionnaire based survey. Urol Oncol. 2010;28(5):500-3. [Crossref] [PubMed]
- Friedlander DF, Resnick MJ, You C, Bassett J, Yarlagadda V, Penson DF, et al. Variation in the intensity of hematuria evaluation: a target for primary care quality improvement. Am J Med. 2014;127(7):633-40.e11. [Crossref] [PubMed] [PMC]
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