Radikal gastrektomi sonrası eş zamanlı kemoradyoterapi uygulanan lokal ileri evre mide kanserlerinde mide kanseri prognostik indeksinin önemi

Year 2022, Volume: 15 Issue: 2, 301 - 310, 31.08.2022

Ahmet Küçük , Düriye Öztürk , Hüseyin Pülat , Recep Çağlar , Şükran Eskici Öztep , Eda Bengi Yılmaz , Erkan Topkan

https://doi.org/10.26559/mersinsbd.1059591

Abstract

Amaç: Radikal gastrektomi sonrası eş zamanlı kemoradyoterapi ile tedavi edilen lokal ileri evre mide kanseri hastalarında albümin ve metastatik lenf nodu sayısının bir kombinasyonu olan yeni mide kanseri prognostik indeksinin önemi araştırılmıştır. Yöntem: Bu retrospektif çalışmamıza Ocak 2014 ile Aralık 2019 tarihleri arasındaki hastalar dahil edilmiştir. Albümin için eşik değer 3.5 g/dL kabul edilirken, metastatik lenf nodu sayısı için ideal eşik değerini tanımlamak amacıyla ‘’receiver operating characteristic’’ eğrisi analizi kullanılmıştır. Bulgular: Çalışmamıza toplam 137 hasta dahil edilmiştir. Albümin 3.5 g/dL (<3.5’e karşılık ≥3.5 g/dL) ve metastatik lenf nodu sayısı için ise eşik değer 5’e göre (<5’e karşılık ≥5) dört olası grup oluşturulmuştur. Grup-1: Albümin ≥3.5 g/dL ve metastatik lenf nodu sayısı <5 Grup-2: Albümin ≥3.5 g/dL ve metastatik lenf nodu sayısı ≥5, Grup- 3: Albümin <3.5 g/dL ve metastatik lenf nodu sayısı <5 ve Grup-4: Albümin <3.5 g/dL ve metastatik lenf nodu sayısı ≥5. Sağ kalım analizlerinde Grup 2 ve Grup 3 arasında anlamlı bir fark bulunmadığı için bu iki grup birleştirilerek mide kanseri prognostik indeksi-2 oluşturulmuştur. Kaplan-Meier eğrilerinden mide kanseri prognostik indeksi-1 ve mide kanseri prognostik indeksi-3 gruplarının sırasıyla progresyonsuz (66.0 aya karşı 16.4 ay; p<0.001) ve genel sağ kalım (66.0 aya karşı 19.5 ay p<0.001) sonuçlarına sahip olduğu belirlenmiştir. Çok değişkenli analiz sonuçları yeni mide kanseri prognostik indeksinin genel (p<0.001) ve progresyonsuz sağ kalım (p=0.05) için bağımsız bir prognostik faktör olduğunu göstermiştir. Sonuç: Çalışmamızdan elde edilen sonuçlar mide kanseri prognostik indeksinin güçlü ve bağımsız bir belirteç olduğunu göstermiştir

Keywords

Eş zamanlı kemoradyoterapi, mide kanseri, sağ kalım sonuçları

The importance of the novel gastric cancer prognostic index in patients with locally advanced gastric cancer who underwent radical gastrectomy and chemoradiotherapy

Abstract

Aim: The significance of the novel gastric cancer prognostic index, hich combines albumin and metastatic lymph node count, on the outcomes of patients with locally advanced gastric cancer who received radical gastrectomy and concurrent chemoradiotherapy, was investigated. Method: Patients who between January 2014 and December 2019 were included in this retrospective analysis. According to the literature, the ideal cutoff value for albumin was determined to be 3.5 g/dL. While, the optimal cutoff for metastatic lymph node count was determined using receiver operating characteristic curve analysis. Results: This retrospective study comprised a total of 137 locally advanced gastric cancer patients. The ideal albumin cutoff was chosen to be the classically referred 3.5 g/dL (<3.5 versus ≥3.5 g/dL), while the results of the receiver operating characteristic curve analysis revealed the ideal metastatic lymph node count cutoff as 5 (<5 versus ≥5). Hence, the study population was divided into four possible groups: Group-1: albumin ≥3.5 g/dL and metastatic lymph node count <5, Grup-2: albumin ≥3.5 g/dL and metastatic lymph node count ≥5, Grup- 3: albumin <3.5 g/dL and metastatic lymph node count <5, and Grup-4: albumin <3.5 g/dL and metastatic lymph node count ≥5. Since of groups 2 and 3 were statistically indistinguishable, we merged them into a single group to create gastric cancer prognostic index-2. The Kaplan-Meier curves revealed that the gastric cancer prognostic index-1 and gastric cancer prognostic index-3 represented progression-free (66.0 versus 16.4 months; p<0.001) and overall survival (66.0 versus 19.5 months, p<0.001) respectively. The results of the multivariate analysis confirmed the gastric cancer prognostic index grouping's independent prognostic significance for overall (p<0.001) and progression-free survival (p=0.05) outcomes. Conclusion: The findings of this study gastric cancer prognostic index may be utilized as an independent and precise prognostic indicator.

Keywords

Concurrent chemoradiotherapy, gastric cancer, survival results

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