Incidencias de segundas neoplasias en los pacientes con carcinoma de vejiga no musculoinfiltrante. Implicaciones clinico asistenciales

Abstract

The prevalence of two or more than two malignant tumours in the same patient has increased for several reasons in the last decades. This is because the life expectancy has increased, the extensive use of X-ray and chemotherapy to treat de first tumour, and a higher genetic vulnerability to the environmental and hereditary factors. The monitoring of cancer is focused in the detection of local recurrence and metastasis of the primary cancer in many areas of oncology at the moment. According to some investigations, it has been seen an increase in the incidence of pulmonary tumour in patients who have suffered a previous bladder tumour. We took this aspects together and we formulated the hypothesis if it would be pertinent to define a new monitoring guideline for patients who have suffered a bladder tumour in order to diagnose a possible pulmonary tumour in an early and curative stage during its monitoring. It would contribute to improve their survival. MATERIAL AND METHODS Data related to nonmuscle infiltrated bladder tumour were collected from the Registry of Tumours of the Hospital del Mar (RTHMar) between the years 1992 and 2005. We conulted patients´comuperized clinical histories. The sample was made up of 579 patients. The objectives of this study were the following ones: Main objectives: 1. To analize the SIR (risk accumulated incidence during monitoring) of pulmonary cancer in patients with nonmuscle infiltrated bladder cancer compared with general population. 2. To analize the survival of patients with single urothelial cancer versus the survival of the patients who presented pulmonary cancer in addition. Secondary objectives: 3. To analize the time interval between bladder tumour diagnosis and pulmonary tumour diagnosis. 4. To analize the relation between pulmonary cancer and the degree and stage of the bladder tumour. RESULTS 1. Risk of accumulated incidence of pulmonary tumour in patients with bladder tumour. The SIR (CI 4.78-14.67) indicates that the accumulated probability when the lung cancer is presented is 8.75 times higher in patients with bladder cancer than in the general population. 2. Survival of patients who suffered from single bladder cancer versus survival of patients who suffered from pulmonary cancer in addition. The results show that survival in patients who just suffered from bladder cancer was 138.68 months, in contrast to the 32.36 months that presented patients who presented lung and bladder cancer. These results were statistically significant (p<0,001). 3. Time interval between bladder cancer diagnosis and pulmonary tumour diagnosis. The average of this period was 51.70 months and it would be the period when we could make the screening tests to make an early diagnosis of lung cancer in patients with nonmuscle infiltrated bladder cancer. 4. Relation between lung cancer and the grade of bladder cancer. We observed that most of the lung tumours appeared in patients with a nonmuscle infiltrated bladder tumour grade 2 and 3, although these results weren´t statistically significant (p>0.65). 5. Relation between pulmonary cancer and the stage of the bladder tumour. It was observed that most of the pulmonary tumours were found in patients with a Ta stage of nonmuscle infiltrated bladder tumour, although these results weren´t statistically significant (p>1.00). CONCLUSIONS 1. Patients with nonmuscle infiltrated bladder cancer constitute a risk group to develop lung cancer. 2. Patients with bladder cancer have more risk of suffering from pulmonary cancer during their monitoring than general population. 3. Survival of patients with single urothelial cancer is higher than the survival of patients who also suffered from lung cancer. 4. There is a period between the bladder tumour diagnosis and the lung tumour diagnosis when it would be indicated to realize a diagnostic test in order to find or discard pulmonary cancer. 5. Lung cancer screening doesn't exist in the habitual protocol of monitoring of patients with bladder cancer at the moment. We think that lung cancer screening is justified in these patients and we will be able to diagnose lung cancer in an early stage where the treatment is possible, although we are conscious that there isn´t any test that have reached a consensus to be used as population screening. Thorax X-ray is not able to discriminate lung cancer early and conventional CAT is too invasive as a routine test. Nevertheless very low radiation new generation CAT, as well as recent genetic tests that are not yet commercialized could be the tests that we advocated as screening.

Date of Award	7 Jul 2010
Original language	Spanish
Supervisor	Antoni Gelabert Mas (Director)