Radikal Radyokemoterapi/Radyoterapi Uygulanan Serviks Karsinomu Olgularında Açlık Kan Şekeri Düzeylerinin Tedavi Sonuçlarına Etkisi

Year 2017, Volume: 20 Issue: 3, 1 - 8, 04.08.2019

Didem İkiz Esra Korkmaz Kıraklı Senem Demirci Aras Arif Zeynep Özsaran

Abstract

Başlık: Radikal Radyokemoterapi/Radyoterapi Uygulanan Serviks Karsinomu Olgularında Açlık Kan Şekeri Düzeylerinin Tedavi Sonuçlarına Etkisi

Türkçe Özet

Amaç: Serviks kanseri dünya
genelinde kadınlarda en sık görülen dördüncü kanserdir. Kanser olgularında
yüksek kan şekeri düzeylerinin düşük sağkalımla ilişkisini gösteren birçok
klinik çalışma yayınlanmıştır. Serviks kanserinde de artmış açlık kan şekeri (AKŞ)
düzeyleri artmış mortalite ile ilişkili bulunmuştur. Bu çalışmada radikal radyokemoterapi/radyoterapi
uygulanan serviks karsinomu olgularında AKŞ düzeylerinin yineleme ve genel
sağkalıma (GS) etkisinin araştırılması amaçlanmıştır.

 

Gereç ve Yöntem: 2005-2013
arasında evreIB-IVB serviks karsinomu tanısıyla eşzamanlı
radyokemoterapi/radyoterapi uygulanan 150 olgunun verileri geriye dönük olarak
analiz edilmiştir. AKŞ değerleri tedavi öncesi, tedavi sırası ve tedavi sonrası
olmak üzere 3 ayrı dönemde incelenmiştir <100mg/dl normal-AKŞ, ≥100 ve ˂126mg/dl pre-dyiabetik
AKŞ, ≥126mg/dl diyabetik-AKŞ
olarak kabul edilmiştir.

 

Sonuçlar: Ortanca takip süresi 64
aydı. 5 yıllık GS %57, hastalıksız sağkalım %46’idi. Üç tedavi dönemindeki AKŞ
değerlerinin lokal-bölgesel yineleme, uzak yineleme ve GS tahmin için ROC
analizi yapıldığında, 100 mg/dl düzeyinin; uzak yineleme için tedavi öncesi
dönemde duyarlılığının % 89, özgüllüğünün % 48 (AUC: 0.69, CI: 0.58-0.80)
p:0.003, yine uzak yineleme için tedavi sonrası dönemde duyarlılığının % 86,
özgüllüğünün % 43 (AUC: 0.69, CI: 0.57-0.80) p:0.004 ve GS için tedavi sonrası
dönemde duyarlılığının % 70, özgüllüğünün % 44 (AUC: 0.61, CI: 0.50-0.72)
p:0.039 olduğu tespit edilmiştir. Tedavi sonrası dönemde uzak yineleyen ve ex
olan olguların ortanca AKŞ düzeyleri uzak yinelemeyen ve yaşayan olgulara göre
anlamlı olarak daha yüksek bulunmuştur.

 

 

Sonuç: Tedavi öncesi ve sonrası
dönemde 100 mg/dl üzeri AKŞ düzeyleri tedavi sonuçlarını kötüleştirebilir. Uzak
yineleyen ve ex olan olgularda tedavi sonrası dönemde AKŞ seviyeleri
yinelemeyen ve sağ olgulara göre daha yüksektir. 

İngilizce Özet (Abstract)

Aim: Cervical
cancer is the fourth common cancer in women worldwide. The importance of
glucose metabolism in cancer developement and progression has been focus of
interest in recent years. Increased blood glucose level has been proven to be
related with increased mortality in cervical cancer. The aim of this study, is
to evaluate the relation between fasting blood glucose levels(FBG) and
treatment outcomes in cervical cancer treated with radical radiochemotherapy/radiotherapy.

 

Material and
Methods: The medical
records of 150 patients with stage IB-IVB cervical cancer treated with radical
radiotherapy/radiotherapy between 2005-2013 were reviewed retrospectively. FBG
levels were recorded in pre-treatment, treatment and post-treatment periods and
were categorised as normal if FBG is <100mg/dl, as pre-diabetic if FBG is
≥100mg/dl and ˂126mg/dl, as diabetic if FBG is ≥126 mg/dl.

 

Results: Median
follow-up was 64 months. 5y OS was 57%, 5y DFS was 46%. ROC analyis for FBG was
carried out for 3 different treatment periods to predict DM and OS; for 100mg/dl
in pre-treatment period was found to have 89% sensitivity,48% specifity (AUC:0.69,
CI:0.58-0.80) p:0.003 for  DM, 100mg/dl
in post-treatment period was found to have 86% sensitivity,43% specifity (AUC:0.69,CI:0.57-0.80)
p:0.004 for DM,  100mg/dl in post-treatment
period was found to have 70% sensitivity,44% specifity (AUC:0.61, CI:0.50-0.72)
p:0.039  for OS. Patients with DM and
died patients had significantly higher median FBG level in post-treatment
period compared to non-relapsing and alive patients,

 

Conclusion: 100 mg/dl FBG
levels  in pre and post-treatment period might
worsen treatment outcomes. The patients with DM and shorter survival had higher FBG levels in post-treatment period.

Keywords

serviks karsinomu; hiperglisemi; tedavi sonuçları

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