The validity of modern diagnosis of the urinary bladder cancer. Are there predictors of under-diagnosis?
Introduction. Given the overall implementation of radical cystectomy (RC) the underusage of this method in treatment of urinary bladder cancer (UBC) remains high. The low rate of accuracy of the clinical staging of UBC actualizes the search of clinical factors, determining the choice of tactics and timeliness of indication for RC surgery. Materials and methods. Retrospective estimation of the accuracy of clinical UBC staging among the patients who underwent RC (n=349) with the purpose of revelation risk factors of UBC under-diagnosis. Results of the research. In case of clinical non-muscle intrusive UBC (with nmicub) of high risk each one of three patients(35,9%) has more higher pathological stage of UBC. In case of clinical muscle intrusive UBC (with cmicub) each one of three patients (31,6%) has locally advanced UBC (LAUBC). In case of LAUBC each one of four patients (28,9%) has mire lower pathological stage of UBC. General accuracy of the estimation of UBC clinical stage is 57,3%. Sensitivity of the CT (MRT) in determination of regional lymph nodes increase is 71,9%, and specificity - 60,7%. The analysis of UBC clinical staging accuracy based on two criteria (cT and cN) helped to determine maximal rate of under-diagnosis in case of LAUBC at the cT3b stage (42,5%), in structure of primary and recurrent patients, primary patients with high risk nmicub (43,5%). Total under - diagnosis rate based on cT and cN is 36,7%. Clinical-statistic analysis determined significant UBC under-diagnosis risk factors based on cT and cN: the involvement of neck of the urinary bladder and urethra into tumor stage, the presence of ureterohydronephrosis caused by UBC blastoma, the presence of anemia and high potential of malignant neoplasms (cG2-4). Discussion. In practical terms every one of three patients (36,7%) being a candidate for RC surgery - is clinically underestimated concerning stage and/or on condition of the regional lymph nodes and has worse oncological postoperational prognosis compared to the one made before the surgery. Conclusion. Taking into acount the state of modern clinical UBC diagnostics, the risk of under-diagnosis based on cT and cN (36,7%) is still high. The involvement neck of the urinary bladder and urethra into tumor stage, the presence of ureterohydronephrosis caused by UBC blastoma, the presence of anemia and high potential of malignant neoplasms (cG2-4) are significant predictors of clinical under-diagnosis of UBC based on stage and regional lymphoid metastasis.