Metastatik kolon kanserinde prognostik faktörlerin analizi

Abstract

Amaç: Kolorektal kanser (CRC), kansere bağlı ölümlerin ikinci önde gelen nedeni ve dünya genelinde en sık görülen üçüncü kanser türüdür. Bununla birlikte, tümör biyolojisinin karmaşıklığı nedeniyle, güvenilir prognostik faktörlerin belirlenmesi hayati önem taşımaktadır. Gereç ve Yöntemler Balikesir Ataturk Şehir Hastanesi'nde takip edilen metastatik kolon kanseri olan 71 hastanın retrospektif analizi gerçekleştirildi. Trombosit-lenfosit oranı (PLR), nötrofil-lenfosit oranı (NLR) ve sistemik immün-enflamasyon indeksi (SII) hesaplandı. Sağkalım analizi Kaplan-Meier yöntemi kullanılarak yapıldı ve prognostik faktörler Cox regresyon analizi ile değerlendirildi. Sonuçlar: Ortalama genel sağkalım (OS) 34,8 ay idi. Vücut kitle indeksi (BMI) <20 kg/m² olan hastalarda sağkalım anlamlı derecede daha kısaydı (21 ay; p = 0,001). Doğu Kooperatif Onkoloji Grubu Performans Durumu (ECOG PS) ≥2, de novo metastaz varlığı ve periton metastazları, daha kötü sağkalımla ilişkiliydi. Tek değişkenli analizde, yüksek PLR (HR: 1,81) ve yüksek SII (HR: 2,16) anlamlı olarak artmış mortalite ile ilişkiliydi. Tümör belirteçleri arasında, yüksek karbonhidrat antijeni 19-9 (CA 19-9) (HR: 1,86) ve daha belirgin olarak yüksek karsinoembriyonik antijen (CEA) (HR: 3,83) sağkalımı olumsuz etkiledi. Çok değişkenli analiz, ECOG PS ≥2, periton metastazı, yüksek SII ve yüksek CEA’yı bağımsız prognostik faktörler olarak tanımladı. Yaş, cinsiyet, tümör yeri, mutasyon durumu ve karaciğer metastazı istatistiksel olarak anlamlı prognostik faktörler değildi. Sonuç: Klinik faktörler (ECOG PS, BMI), metastaz özellikleri (peritoneal, de novo), inflamatuar belirteçler (PLR, SII) ve tümör belirteçleri (CA 19-9, CEA), metastatik kolon kanserinde sağkalımın önemli belirleyicileridir. Özellikle CEA, güçlü bir bağımsız prognostik faktör olarak ortaya çıkmıştır.

Keywords

• kolorektal kanser
• metastatik
• prognostik faktörler
• trombosit-lenfosit oranı (PLR)
• sistemik immün-enflamasyon indeks (SII)

Analysis of prognostic factors in metastatic colon cancer

Abstract

Aim: Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths and the third most common cancer globally. However, due to the complexity of tumor biology, identifying reliable prognostic factors remains crucial. Material and Methods: We conducted a retrospective analysis of 71 patients with metastatic colon cancer who were followed at Balikesir Ataturk City Hospital. The platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were calculated. Survival analysis was performed using the Kaplan-Meier method and prognostic factors were evaluated with Cox regression analysis. Results: The median overall survival (OS) was 34.8 months. Survival was significantly shorter in patients with a BMI <20 kg/m² (21 months; p = 0.001). An Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2, the presence of de novo metastases, and peritoneal metastases were all associated with poorer survival. In univariate analysis, elevated PLR (HR: 1.81) and elevated SII (HR: 2.16) were significantly associated with increased mortality. Among tumor markers, elevated carbohydrate antigen 19-9 (CA 19-9) (HR: 1.86) and, more prominently, elevated carcinoembryonic antigen (CEA) (HR: 3.83) negatively impacted survival. In the multivariate Cox regression analysis, ECOG performance status ≥2, the presence of peritoneal metastasis, elevated systemic immune-inflammation index (SII), and elevated carcinoembryonic antigen (CEA) were identified as independent prognostic factors for overall survival. Conclusion: Clinical factors (ECOG PS, BMI), metastasis characteristics (peritoneal, de novo), inflammatory markers (PLR, SII), and tumor markers (CA 19-9, CEA) are significant predictors of survival in metastatic colon cancer. CEA, in particular, emerged as a strong independent prognostic factor.

Keywords

• colorectal cancer
• metastatic
• prognostic factors
• platelet-to-lymphocyte ratio (PLR)
• systemic immune-inflammation index (SII)

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