Evre 3 Kolorektal Karsinom Tanılı Hastalarda Tümör Yerleşim Yerinin Nüks, Prognoz ve Sağ Kalım Üzerine Etkisi

Öz

Amaç: Kolorektal kanserlerde prognozu etkileyen birçok faktör vardır. Son yıllarda tümör yerleşim yerinin de prognoz üzerine etkisini gösteren çalışmalar mevcuttur. Çalışmamızın amacı; Evre 3 kolon kanser tanılı hastalarda genel sağ kalım ve nüks oranının, tümör lokalizasyonu ile ilişkisini değerlendirmektir.Gereç ve Yöntemler: Çalışmaya evre 3 kolorektal kanser tanılı, Akdeniz Üniversitesi Tıp Fakültesi’nde takip edilen hastalar dahil edildi. 231 hastanın bilgilerine retrospektif olarak hastane veritabanı kullanılarak ulaşıldı. Hastalar tümör lokalizasyonuna göre, literatürdeki çalışmalara benzer olarak sağ ve sol kolon kanseri olarak gruplandırıldı ve verileri analiz edildi.Bulgular: Hastaların 171’in de %74 sol kolon tümörü; 60’ın da %26 sağ kolon tümörü tespit edildi. Hastaların tümör yerleşim yeri ile nüks oranları arasında anlamlı bir fark saptanmadı p=0,82 . Sol kolon kanserleri için ortalama GSK 97,5±6,6 %95 CI, 84,6-110,5 ay, sağ kolon kanserleri için 74,3±5,7 %95 CI, 63,0-85,5 ay olarak saptandı. Sol kolon kanserlerinde ortalama GSK süresi daha yüksek olmakla birlikte gruplar arası istatistiksel anlamlı bir fark saptanmadı p=0,38 . Sonuç: Kolon kanserinde tümör lokalizasyonu ile prognoz arasında ilişki olabileceği düşünülmektedir. Bizim çalışmamızda evre 3 hastalıkta sağ kolon kanserlerinin prognozu daha kötü görülmekle birlikte gruplar arasında istatistiksel anlamlılık gösterilemedi. Bu konuda ileride yapılacak çalışmaların klinik uygulamada yararlı olabileceği görüşündeyiz

Anahtar Kelimeler

• Prognoz, Evre 3 kolon kanseri, Tümör lokalizasyonu

Does Location of the Tumor Affect Prognosis, Survival, and Relapse in Patients With Stage 3 Colorectal Cancers?

Abstract

Objective: There are many factors that affect prognosis in colorectal cancers. Recent studies have shown the effect of tumor location on the prognosis. The purpose of our study is to evaluate the relationship between tumor location and the overall survival and recurrence rate in patients with stage 3 colon cancer.Material and Methods: Patients diagnosed with stage 3 colorectal cancer and followed up at the Akdeniz University Medical Faculty were included in the study. 231 patients' information was accessed retrospectively using the hospital database. Patients were grouped into right and left colon cancers similar to those in the literature according to tumor location, and all data were analyzed.Results: 171 74% patients had left colon cancer whereas right colon cancer was present in 60 26% . There was no significant relationship between the tumor location and recurrence rates of the patients p=0.82 . The mean overall survival for left colon cancers was 97.5±6.6 95% CI, 84.6110.5 months; for right colon cancers it was 74.3±5.7 95% CI, 63.0-85.5 months. Although the mean duration of overall survival was higher in left colon cancers, there was no statistically significant difference between the groups p=0.38 Conclusion: We think that there may be a relationship between tumor location and prognosis in colon cancer. In our study, the prognosis was worse in right colon cancer but no statistically significant difference was found between the groups. The relationship between tumor location and survival in stage 3 disease could not be shown clearly. Future studies on this subject may be useful in clinical practice

Keywords

• Prognosis, Stage 3 colon cancer, Tumor location

References

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2013. CA Cancer J Clin 2013; 63:11-30.
2. Mik M, Berut M, Dziki L, Trzcinski R, Dziki A. Right- and left sided colon cancer - clinical and pathological differences of the disease entity in one organ. Arch Med Sci 2017; 13(1):157-62.
3. Arıncı K, Elhan A. Anatomi Cilt I. 4. Baskı. Ankara, Güneş Kitabevi 2006; 251-61.
4. Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E, Beier F, Esser R, Lenz HJ, Heinemann V. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: Retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol 2017; 3(2):194-201.
5. Kumar V, Cotran RS, Robbins SL. Temel patoloji. Çevikbaş U (Ed). 7. Baskı. İstanbul, Nobel Tıp Kitabevleri 2003; 580-5.
6. Papadakis MA, Mcphee SJ. Current medical diagnosis and treatment. Rabow MW (ed). 55. Baskı. New York, McGraw-Hill Education 2016;1615-22.
7. Huang CW, Tsai HL, Huang MY, Huang CM, Yen YS, Ma CJ, Wang JY. Different clinicopathologic features and favorable outcomes of patients with stage III left-sided colon cancer. World J Surg Oncol 2015; 13:257.
8. Venook AP, Niedzwiecki D, Innocenti F, Fruth B, Greene C, O’Neil BH, Shaw J, Atkins J, Horvath LE, Polite B, Meyerhardt JA, O’Reilly EM, Goldberg R, Hochster HS, Blanke CD, Schilsky R, Mayer RJ, Bertagnolli M, Lenz HJ. Impact of primary tumor location on overall survival (OS) and progression-free survival (PFS) in patients (pts) with metastatic colorectal cancer (mCRC): Analysis of CALGB/SWOG 80405 (Alliance) [abstract]. In: 2016 ASCO Annual Meeting; Chicago (IL), USA. Alexandria (VA): American So ciety of Clinical Oncology, 2016.

9. Warschkow R, Sulz MC, Marti L, Tarantino I, Schmied BM, Cerny T, Güller U. Better survival in right-sided versus left-sided stage I - III colon cancer patients. BMC Cancer 2016; 16:554.
10. Jung MK, Shin US, Ki YJ, Kim YB, Moon SM, Sung SJ. Is the location of the tumor another prognostic factor for patients with colon cancer?. Ann Coloproctol 2017; 33(6):210-8.
11. Holch JW, Ricard I, Stintzing S, Modest DP, Heinemann V. The relevance of primary tumor location in patients with metastatic colorectal cancer: A meta-analysis of first- line clinical trials. Eur J Cancer 2017; 70:87-98.
12. Liu F, Li C, Jia H, Yang L, Wu Y, Zhao J, Cai S, Zhu J, Xu Y. Is there a prognostic value of tumor location among Chinese patients with colorectal cancer?. Oncotarget 2017; 8(24):38682-92.
13. Moritani K, Hasegawa H, Okabayashi K, Ishii Y, Endo T, Kitagawa Y. Difference in the recurrence rate between right- and left-sided colon cancer: A 17-year experience at a single institution. Surg Today 2014; 44(9):1685-91.
14. Qiu MZ, Pan WT, Lin JZ, Wang ZX, Pan ZZ, Wang FH, Yang DJ, Xu RH. Comparison of survival between right- sided and left-sided colon cancer in different situations. Cancer Medicine 2018; 7(4):1141-50.
15. Gervaz P, Bucher P, Morel P. Two colons-two cancers: Paradigm shift and clinical implications. J Surg Oncol 2004; 88:261-6.
16. Yamauchi M, Lochhead P, Morikawa T, Huttenhower C, Chan AT, Giovannucci E, Fuchs C, Ogino S. Colorectal cancer: A tale of two sides or a continuum? Gut 2012; 61: 794-7.
17. Schrag D, Weng S, Brooks G, Meyerhardt JA, Venook AP. The re lationship between primary tumor sidedness and prognosis in colorectal cancer [abstract]. In: 2016 ASCO Annual Meeting; 2016 Jun 3-7; Chicago (IL), USA. Alexandria (VA): American So ciety of Clinical Oncology; 2016.
18. Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumor side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six random ized trials. Ann Oncol 2017; 28:1713-29.
19. Benson AB, Venook AP, et al. NCCN guidelines version 2.2017 colon cancer. Mart 2017. Available online: https:// www.nccn.org.