Lokalize Prostat Kanserli Hastalarda Aktif Kriterler Mevcut Kriterler Uygun mu?

Year 2019, Volume: 16 Issue: 1, 57 - 62, 22.03.2019

Yiğit Akın , Sacit Nuri Görgel Osman Köse Esra Meltem Koç , Yüksel Yılmaz Serkan Özcan , Enis Mert Yorulmaz

Abstract

Amaç: Gleason skorlama sistemindeki parametreleri, aktif
sürveyansa (AS) uygun düşük riskli prostat kanserli hastalarda (PCa)
belirlemeyi hedefledik.

Materyal
ve Metod: 2007-2017 yılları
arasında PCa nedeniyle radikal prostatektomi yapılan 153 hastanın tıbbi
kayıtlarını geriye dönük olarak inceledik. Biyopsi ile cerrahi Gleason skoru
arasında potansiyel yükselme öngören parametreler değerlendirildi. Tüm hastalarda
D’Amico risk sınıflamasına göre düşük riskli klinik PCa vardı. Yaş, vücut kitle
indeksi (VKİ), Prostat Spesifik Antijen yoğunluğu (PSAD) ve sigara içme durumu
gibi demografik ve klinik parametreler değerlendirildi. Kaydedilen
parametrelerin, yükseltme için Gleason skorlama sistemi üzerindeki etkilerini
inceledik. Tüm patoloji materyalleri deneyimli bir patoloji kliniği tarafından
değerlendirildi. Anlamlı p, p <0.05 olarak kabul edildi.

Bulgular: Ortanca takip süresi 113,4 ay (1-144 ay) idi. Ortalama
yaş 62.9 ± 6.07 idi. Gleason derecelendirme sisteminde yükselme nedenleri aktif
sigara içicisi olmak için BMI≥30, PSA yoğunluğu .1.15, Kaplan-Meier ve log-rank
testleri analizlerinde sırasıyla 65 yıl (hepsi p <0.05) idi. Tek değişkenli
analizler Yaş, VKİI, PSA yoğunluğu >0.15 ve aktif sigara tiryakisi
durumlarının istatistiksel olarak anlamlı prognostik faktörler olduğunu
gösterdi (sırasıyla; p:0.007, p <0.001, p <0.001, p <0.001).

Sonuç: Mevcut Kriterler, PCa düşük riskli PCa hastalarının
tümü için yararlı olamamıştır. AS, VKİ yükselmiş olan PCa hastaları için uygun
görünmemektedir.

Keywords

Aktif izlem, gleason skoru, prostat kanseri, Vücut kitle indeksi

Are current criteria eligible for active surveillance in patients with localized prostate cancer?

Abstract

Background: We aimed to determine the parameters on the Gleason scoring system to upgrade in patients with the low-risk prostate cancer (PCa) that were suitable for active surveillance (AS).

Methods: We retrospectively analyzed medical records of 153 patients who underwent radical prostatectomy because of PCa between 2007 and 2017. Potential predictors of upgrading were evaluated between the biopsy and surgical Gleason score. All patients had clinical low-risk PCa according to D’Amico risk classification. Demographic and clinical parameters including age, body mass index (BMI), Prostate Specific Antigen density (PSAD), and smoking status were evaluated. We examined the effects of recorded parameters on the Gleason scoring system to upgrade. All pathology materials were evaluated by an experienced pathology clinic. Significant p was accepted as p<0.05.

Results: Median follow-up period was 113,4 months (range, 1-144 months). Mean age was 62.9± 6.07 years. Causes to upgrade in Gleason grading system were BMI≥30, PSA density≥0.15, to be an active smoker, and age≥ 65 years in Kaplan-Meier and log-rank tests analyses, respectively (all p<0.05). Univariate analyses showed that Age, BMI, PSA density≥0.15 and active smoker statuses were statistically significant prognostic factors (respectively; p:0.007, p<0.001, p<0.001, p<0.001).

Conclusion: Current Criteria for AS could not be useful for all PCa low-risk PCa patients. AS does not seem to be appropriate for PCa patients with Elevated BMI.

Keywords

Active surveillance, Body mass index, Gleason score, Prostate cancer

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