Axiller lenf nodu pozitif meme kanserinde non-sentinel lenf nodu pozitifliğine etki eden faktörler ve nomogramların etkinliğinin karşılaştırılması

Year 2018, Volume: 45 Issue: 4, 397 - 406, 13.12.2018

Bülent Koca Bekir Kuru

https://doi.org/10.5798/dicletip.497892

Abstract

Amaç: Amacımız aksiller lenf nodu pozitif meme kanserinde
nonsentinel lenf nodu (NSLN) pozitifliğine etki eden faktörleri araştırmak ve
hasta grubumuzda Memorial Sloan-Kettering Cancer Center (MSKCC) ve Stanford
nomogramlarının etkinliğini karşılaştırmaktır.

Yöntemler: 01.01.2008 - 31.08.2011 tarihleri arasında
Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği’nde sentinel
lenf nodu biyopsisi (SLNB) sonucunda sentinel lenf nodunda metastaz saptanan invaziv
meme kanseri olan 112 hasta çalışmaya alındı. Karşılaştırılacak değişkenler
SPSS 15.0 versiyonu programından yararlanılarak kaydedildi. Lojistik regresyon
analizi ile NSLN pozitifliğine etki eden risk faktörleri araştırıldı. P<
0.05 anlamlılık düzeyi olarak kabul edildi. Her iki nomogram icin “Receiver
Operating Characteristics (ROC)” eğrileri oluşturuldu ve eğriler altındaki
alanlar(AUC) hesaplandı. AUC değeri 0.70 ve üzerinde hesaplanan yöntem etkin
olarak kabul edildi.

Bulgular: Tek değişkenli analizde tümör boyutu,
multifokalite, lenfovasküler invazyon varlığı, SLN’daki metastazın
makrometastaz oluşu, SLN’da kapsül dışı invazyon varlığı ve metastatik SLN
sayısının toplam SLN sayısına oranı anlamlı bulundu. Çok değişkenli analizde
lenfovasküler invazyon, SLN’da kapsül dışı invazyon ve metastatik SLN sayısının
toplam SLN sayısına oranı NSLN metastazı ile ilgili bağımsız prediktif
faktörler olarak saptandı. MSKCC ve Stanford nomogramlarının ikisinin de hasta
grubumuzda etkin olmakla birlikte MSKCC nomogramının daha etkin olduğu sonucuna
vardık.

Sonuç: Nomogramlar aksillada NSLN’unda metastataz olasılığı
hakkında yol gösterici yöntemlerdir. Ancak henüz aksiller lenf nodu
diseksiyonunun (ALND) yerini alacak kapasitede değildirler. NSLN pozitifliğine
etki eden yeni prediktif faktörlerin ortaya konulması ile etkinlikleri
artırılabilir. Her klinik kendisine en uygun nomogramı belirlemeli ve kullanmalı
veya kendi nomogramını oluşturmalıdır.

Keywords

Meme kanseri, Non-sentinel lenf nodu pozitifliği

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