Razvoj bodovnog sistema u predviđanju ekstravezikalnog karcinoma mokraćne bešike
Sažetak
Uvod/Cilj. Stadiranje raka mokraćne bešike je od ključne važnosti u optimalnom lečenju bolesti. Kliničko stadiranje, međutim, nije dovoljno pouzdano. Cilj rada bio je da se izvede jednostavan bodovni sistem u predviđanju patološki uznapredovalog, mišićnoinvazivnog raka mokraćne bešike (MIBC). Metode. Logistička regresija i samodopunjujuća metoda korišćena je za izradu celobrojnog skora procenjenog rizika predviđanja patološki uznapredovalog MIBC uz pomoć kliničkopatoloških podataka pre učinjene cistektomije: demografskih karakteristika, inicijalne transuretalne resekcije (TUR) tumora mokraćne bešike [gradus, stadijum, brojnost tumora, limfovaskularna invazija (LVI)], prisustva hidronefroze, abdominalne i pelvične kompjuterizovane tomografije (veličina tumora, veličina baze tumora) i patološkog stadiranja nakon učinjene radikalne cistektomije (RC). Uznapredovali MIBC u hirurškom uzorku definisan je nalazom pT3-4 tumora. Prediktivna tačnost je procenjena površinom ispod receiving operating characteristic (ROC) krive. Klinička korisnost je procenjena analizom krive odlučivanja. Rezultati. Ova jednocentrična retrospektivna studija uključila je 233 odrasla bolesnika sa BC kod kojih je učinjena RC na Vojnomedicinskoj akademiji u Beogradu. Oboljenje ograničeno na organ utvrđeno je kod 101 (43,3%) bolesnika, dok je 132 (56,7%) imalo uznapredovalo oboljenje. U multivarijatnoj analizi tri faktora rizika bila su tesno povezana sa uznapredovalom bolešću: gradus inicijalne TUR [(odds ratio (OR) = 4,7)], LVI (OR = 2) i hidronefroza (OR = 3,9). Rezultujući ukupan bodovni skor kretao se od 0 do 15 poena sa kritičnom vrednošću iznad 8 poena, a AUC 0.795, ukazujući na dobru diskriminacionu sposobnost. Model je pokazao odličnu kalibraciju. Analiza krive odlučivanja pokazala je neto korist duž svih pragova verovatnoće i kliničku korisnost modela. Zaključak. Sastavili smo jedinstven bodovni sistem koji bi mogao pomoći u predviđanju uznapredovalog MIBC kod bolesnika pre učinjene radikalne cistektomije. Bodovni sistem je pokazao dobre performanse. Primena ovakvog sredstva u svakodnevnom kliničkom odlučivanju mogla bi dovesti do adekvatnije integracije preoperativne hemioterapije. Kliničku vrednost ovog modela treba dalje proceniti eksternom validacijom
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