Evre III rektal kanserlerde kötü sağkalım ile ilişkili yeni prognostik belirteçler: İnvasiv büyüme paterni ve Tümör nekrozu

Year 2019, , 369 - 376, 30.09.2019

Mehmet Zengin

https://doi.org/10.18663/tjcl.572566

Abstract

Amaç:
Rektal kanserler (RK) batı dünyasında en sık görülen
kanserlerden biridir. RK için en önemli prediktif gösterge TNM
sistemidir. Bununla birlikte, aynı tümör evresi ile karakterize
edilen hastalar sıklıkla belirgin farklı sağ kalımlara sahiptir.
Bu araştırmada, stage III RK’larda İnvasiv büyüme paterni
(İBP) ve Tümör nekrozu (TN)’nun hayatta kalmaya etkisini analiz
ettik.

Gereç
ve Yöntemler: 1999-2012 yılları arasında Kırıkkale
Üniversite’sinde stage III RK nedeniyle opere olan yüzkırk beş
hasta bu çalışmaya dahil edildi. Bu parametreler hematoksilen ve
eozin boyalı kesitlerde skorlandı. Sonuçlar ve klinikopatolojik
özellikler arasındaki ilişki analiz edildi.

Bulgular:
Bu
parametreler, büyük boyutlu tümör (İBP:
p<0.001;
TN: p=0.033),
ileri PT (İBP:
p=0.016;
TN: p=0.047),
angiolymphatic
invazyon (İBP: p = 0.025), lenf nodu metastazı sayısı (İBP:
p<0.001; TN: p=0.001),
ileri evre (İBP: p<0.001; TN: p=0.018)
ve ileri grade (İBP: p < 0.001) bulgusu gösteren RK’larda
anlamlı olarak artırıyordu. Tek değişkenli analizde, bu iki
parametreye sahip hastalar 5 yıllık kötü sağkalıma sahipti
([İBP=
RFS: 50%, p=0.001; OS=55%, p=0.003], [TN= RFS: 53%, p=0.005; OS: 58%,
p=0.017]). Çok
değişkenli analizler, bu iki parametrenin RFS (İBP=Hazard
ratio [HR]: 1.58
[1.05-2.66], p=0.005; TN=1.44
[1.07–2.34], p=0.013)
ve OS
(İBP=HR: 1.55 [1.11–3.18], p=0.008; TN= 1.38
[1.09–2.28], p=0.024)
için
bağımsız bir kötü hayatta kalma parametresi olduğunu doğruladı.
Ayrıca,
IGP'nin TN'den daha yararlı olduğu bulundu.

Sonuç:
Verilerimiz İBP ve TN’nin RK için değerli prognostik
bilgiler sağladığını ve mevcut risk sınıflamasına bu
parametrelerin eklenmesinin daha iyi hasta seçimine katkıda
bulunabileceğini göstermektedir.

Keywords

İnvasive büyüme paterni, tümör nekrozu, rektal kanser, prognostik belirteçler

Novel prognostic markers associated with poor survival in stage III rectal cancers: Invasive growth pattern and Tumor necrosis

Abstract

Aim:
Rectal carcinomas
(RC) are one of the most common cancers in the western world. TNM
system is the
most significant predictive indicator in these tumors but
patients characterized by the same stage often have prominent
distinct survival. In
this research, we analyzed the survival effect of
Invasive growth pattern (IGP) and Tumor necrosis (TN) in
stage III RC.

Material
and Methods:
A hundred forty-five
patients operated for stage III RC
during 1999-2012 at Kırıkkale University were included in this
research. These parameters were scored on hematoxylin
and eosin stained sections.
The
relationship between the results and the clinicopathological
characteristics was analyzed.

Results:
These
parameters were significantly upregulated in RCs which classified as
higher
tumor
size (IGP: p<0.001;
TN: p=0.033),
higher
pT
(IGP: p=0.016;
TN: p=0.047),
angiolymphatic invasion (IGP: p=0.025),
high number metastatic lymph nodes (IGP: p<0.001; TN: p=0.001),
advanced stage (IGP: p<0.001; TN: p=0.018),
and advanced grade (IGP: p<0.001). In univariate analysis,
patients with these two parameters had worse 5-year survival ([IGP=
RFS: 50%, p=0.001; OS=55%, p=0.003], [TN= RFS: 53%, p=0.005; OS: 58%,
p=0.017]). Multivariate analyzes confirmed that these
two parameters are
an independent worse survival parameter for RFS (IGP=Hazard ratio
[HR]: 1.58
[1.05-2.66], p=0.005; TN=1.44
[1.07–2.34], p=0.013)
and OS
(IGP=HR: 1.55 [1.11–3.18], p=0.008; TN= 1.38
[1.09–2.28], p=0.024).
In addition, IGP was found to be more successful than TN.

Conclusion:
Our data suggest that IGP and TN provide valuable prognostic
information for RC, and adding these parameters to the current risk
classification may contribute to better patient selection.

Keywords

Invasive growth pattern, Tumor necrosis, rectal cancer, prognostic markers

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