Yaşlı Hastalarda Kolorektal Kanser Tanısında Serum Ferritin Düzeyinin Yeri

Year 2022, , 77 - 83, 29.04.2022

Fatih Karakaya , İrfan Soykan

https://doi.org/10.47493/abantmedj.837087

Abstract

Amaç: Ferritin demir eksiklğinin bir belirtecidir. Kolorektal kanser yaşlı bireylerde önemli bir morbidite ve mortalite sebebidir. Bu çalışmnaın amacı yaşlı bireylerde serum ferritin ve ferritin-transferrin saturasyonunun kolorektal kanser tanısındaki yerini önemini belirlemektir.

Gereç ve Yöntemler: Çalışmaya üst ve alt gastrointestinal endoskopi sonucu olan 65 yaş ve üstü 600 hasta alınmıştır. Serum demir profili ve C-reaktif protein değerleri incelenmiştir. Hastalar ferritin düzeylerine göre üç gruba ayrılmıştır: metod 1: ferritin < 50 µg/L; metod 2: ferritin < 100 µg/L; metod 3: ferritin+transferrin saturasyon indeksi. Her üç metod ile kolorektal kanser varlığı ile serum ferritin düzeyi arasındaki ilişki araştırılmıştır.

Bulgular: 528 hastanın üst ve alt gastrointestinal endoskopi bulguları normaldir. 72 hastada kolorektal kanser saptanırken, bu hastaların hepsinde üst gastrointestinal endoskopi bulguları normal olarak bulunmuştur. Metod 1 (ferritin<50 µg/L) kolorektal kanser varlığını %58.4 oranında tahmin etmiştir (Duyarlılık ve özgünlük sırasıyla %63 ve %53’tür). Buna karşın metod 3’ün duyarlılığı [91% (95% CI:82-96)] metod 1 ve 2’den daha yüksek olup AUROC değeri %70,4’tür. Her üç grupta da median ferritin düzeyleri arasında fark bulunamamıştır. Median transferrin saturasyon indeksi grup I’de (Normal hastalar) grup II’ye (Kolorektal kanserli hastalar) göre daha yüksektir (17.5 vs 8%, p<0.001).

Sonuç: Serum ferritin düzeyi <50 μg/L ve <100 μg/L değerlerinde kolonoskopik incelemeye karar vermekte düşük tanısal değere sahiptir. Buna karşılık serum ferritin düzeyi <100 μg/L ve transferrin saturasyon indeksi <%16 ise yaşlı bireylerde kolonoskopik incelemeye karar vermekte daha yararlı olarak bulunmuştur.

Keywords

Anemi, Kolorektal kanser, Kolonoskopi, Ferritin

Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients

Abstract

Objective: Ferritin is an indicator of iron deficiency. Colorectal cancer is an important cause of morbidity and mortality in older subjects. The aim of this study was to determine the value of serum ferritin and ferritin-transferrin saturation in the diagnosis of colorectal cancer in older subjects.

Material and Methods: 600 older patients who had undergone upper and lower gastrointestinal endoscopic examination were included into the study. Serum iron profile and C-reactive protein were also recorded. Patients were then evaluated by three different ferritin levels according to their iron profiles: method 1: ferritin < 50 µg/L; method 2: ferritin < 100 µg/L; method 3: ferritin+transferrin saturation index. The relationship between existence of colorectal cancer and serum ferritin level was investigated.

Results: 528 patients had normal upper and lower endoscopic findings. 72 patients had colorectal carcinoma with normal upper gastrointestinal findings. Method 1 (ferritin<50 µg/L) predicted 58.4% of patients with colorectal carcinoma with a sensitivity and specificity of 63% (95% CI:52-74) and 53% (95% CI: 48-57) respectively. However, sensitivity [91% (95% CI:82-96)] of method 3 was greater than method 1 and 2 with a AUROC value of 70.4%. There was no difference by means of median ferritin levels. Median transferrin saturation index was significantly higher in group I (Normal subjects) compared to patients in group II (Colorectal cancer patients) (17.5 vs 8%, p<0.001).

Conclusion: Serum ferritin <50 μg/L and <100 μg/L have rather low diagnostic yield in the decision making of colonscopic examination for colorectal carcinoma. However, ferritin <100 μg/L and TSI <16% values can be more useful in selecting older patients for colonoscopic examination.

Keywords

Anemia, Colorectal carcinoma, Colonoscopy, Ferritin

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