Lokal İleri Rektum Kanserli Hastalarda Hemoglobin Düzeylerinin Sağkalım Üzerine Etkisi

Yıl 2025, Cilt: 20 Sayı: 1, 65 - 70

Neslihan Kurtul , Celalettin Eroğlu

https://doi.org/10.17517/ksutfd.1522093

Öz

Amaç: Bu çalışmada kemoradyoterapi ve cerrahi ile birlikte tedavi edilen rektum kanserinde tanı anındaki hemoglobin (Hb) değerinin sağkalım üzerine etkisi olup olmadığı araştırıldı.
Gereç ve Yöntemler: Rektum kanseri nedeniyle neoadjuvan/adjuvan radyoterapi (RT) alan 98 hasta çalışmaya dahil edildi. RT neoadjuvan ya da adjuvan pelvik lenf nodları ve primer tümör alanına 45-54 Gy uygulandı. RT ile eşzamanlı 5-FUFA veya kapesitabin kullanıldı. Sağkalımı belirleyen faktörleri değerlendirmek üzere tek değişkenli ve çok değişkenli Cox regresyon analizi yapıldı. Sağkalım açısından Hb düzeyinde sınır değer olup olmadığını bulmak için ROC analizi yapıldı.
Bulgular: Medyan genel sağkalım 61 ay (%95 CI 31-90), 1 yıllık sağkalım %82, 5 yıllık sağkalım %50 olarak bulundu. Hb sınır değeri %75 duyarlılık ve %50 özgüllükle 13,45 g/dL olarak belirlendi. Hb düşük grupta genel sağkalım 31±8 (%95 CI:14-48) ay yüksek grupta 81±17 (%95 CI:46-116) aydı (p=0.032). T4 tümörlerde ve neoadjuvan grupta Hb düşüklüğünün mortalite üzerine etkisi daha belirgindi. Tek değişkenli Cox regresyon analizinde T evre, N evre ve Hb düzeyinin 13,75 g/dl’nin altında veya üzerinde olması sağkalım üzerine etkili faktörler olarak bulundu. Çok değişkenli Cox regresyon analizinde ise T evre, N evre ve Hb düzeyi sağkalım üzerinde etkili faktörlerdi
Sonuç: Hb düzeyinin 13.45 g/dl'nin altında olması lokal ileri rektum kanserinde, özellikle T4 tümörlü veya neoadjuvan kemoradyoterapi gören hastalarda kötü bir prognostik faktör olduğu görüldü.

Anahtar Kelimeler

Hemoglobin, Radyoterapi, Rektm Kanseri, Sağkalım

Prognostic Significance of Hemoglobin Levels on Survival in Patients with Locally Advanced Rectal Cancer

Öz

Objective: The objective of this study was to investigate whether the hemoglobin (Hb) level at the time of diagnosis was associated with survival in patients with rectal cancer who were treated with chemoradiotherapy and surgery.
Material and Methods: This study was conducted on 98 rectal cancer patients who had undergone neoadjuvant/adjuvant radiation therapy. Radiotherapy was delivered to the pelvic lymph nodes and the primary tumor at a dose of 45–54 Gy. Patients received 5-fluorouracil (5-FUFA)/capecitabine chemotherapy along with radiotherapy. Univariate and multivariate Cox regression analysis were used to evaluate factors determining patient survival. A receiver operating characteristic (ROC) analysis was performed to ascertain the existence of a threshold for Hb levels in relation to survival.
Results: The median overall survival was 61 months (95% CI, 31-90 months). The one-year survival rate was 82%, and the five-year survival rate was 50%. The optimal Hb threshold was identified as 13.45 g/dL, with a sensitivity of 75% and a specificity of 50%. The overall survival was 31±8 months (95% CI; range, 14-48 months) in the low Hb group and 81±17 months (95% CI; range, 46-116 months) in the high group (p = 0.032). It was determined that the impact of low Hb levels on mortality was more pronounced in patients with T4 tumors and in the neoadjuvant treatment group. In the univariate Cox regression analysis, a statistically significant effect on overall survival was observed for T-stage, N-stage, cancer stage and Hb level. In the multivariate Cox regression analysis, T stage, N stage and Hb level were identified as the significant factors influencing survival, independent of other variables
Conclusions: A Hb level below 13.45 g/dL was found to be a poor prognostic factor in locally advanced rectal cancer, particularly in cases with T4 tumors or treated with neoadjuvant chemoradiotherapy.

Anahtar Kelimeler

Hemoglobin, Radiotherapy, Rectal Cancer, Survival

Kaynakça

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