Öz
Amaç: Servikal kanser (SK) tüm dünyada kadınlarda kansere
bağlı ölümlerin en sık 4. Sebebi iken ülkemizde 12. Sebebidir. En önemli
etyolojik neden HPV olması nedeniyle tarama programları ile erken tanı ile kür
olma şansı yüksek olan tümörlerdendir. Ancak ülkemizde SK’lerin uzun dönem
yaşam verileri ile ilgili bilgiler kısıtlıdır. Bizde çalışmamızda öncelikli
olarak SK tanılı hastalarımızın yaşam sürelerini ve bu süreleri predikte eden
faktörleri ortaya koymak istedik.
Materyal ve metod: Erzurum Atatürk Üniversitesi Tıp Fakültesi Tıbbi
Onkoloji Anabilim Dalı'nda 2007-2017 yılları arasında SK nedeniyle takip edilen
70 hasta çalışmaya retrospektif olarakdahil edildi. Genel sağkalım (OS) ve
progresyonsuz sağkalım (PFS) ile klinikopatolojik parametreler arasındaki ilişkiler
Kaplan-Meier eğrileri kullanılarak analiz edildi ve log-rank testi ile karşılaştırıldı.
Tek ve çok değişkenli analiz kriterlerin PFS ve OS için prognostik önemlerini
tespit etmek için kullanılmıştır.
Bulgular: Hastaların median yaşı 56’dır.
En sık görülen histolojik alttip skuamoz hücreli karsinom (%79,5) ardından
adenokarsinom (%16,4) gelmektedir. FIGO evreleme sistemine göre hastaların 31’i
(%43,8) evre 1-2, 42’si (%56,2) evre 3-4 olarak tanı almıştır. Median PFS ve OS
44 ay ve 78 aydır. 5 yıllık yaşam oranı %37,5 (%12-%75) dur. Histolojik
alttiplerin yaşam süreleri arasında fark olmamakla beraber ECOG performans
skoru iyi (0-1) olanların, erken FIGO evresi (1-2) olanların, tumor boyutu
<4 cm olanların, parametrial ve lenf nodu tutulumu olmayanların hem PFS hem
de OS leri daha uzundur. Multivariate analizler sonucunda ECOG performans
skoru, parametrial tutulum ve lenf nodu tutulumu PFS ve OS için bağımsız
prognostik faktör olduğu tespit edilmiştir.
Sonuç: Bölgemizdeki SK’li
hastaların tanı anında evreleri daha ileri ve 5 yıllık yaşam oranları dünya
ortalamalarının altındandır bu sebeple kadınlarımızın bu konuda daha iyi
bilinçlendirilmeleri gerekmektedir
Anahtar Kelimeler
Kaynakça
- 1. Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393(10167):169-182
- 2. Aydoğdu MGS, Özsoy Ü. Cervical cancer and HPV. Androl Bul 2018;20:25−29
- 3. Crosbie EJ, Einstein HM, Franceschi S, Kitchener CH. Human papillomavirus and cervical cancer. Lancet. 2013;382(9895):889-99
- 4. Zhao H, He Y, Yang S, Zhao Q, Wu YM. Neoadjuvant chemotherapy with radical surgery vs radical surgery alone for cervical cancer: a systematic review and meta-analysis. Onco Targets Ther. 2019;12:1881–1891
- 5. Noone AM, Howlader N, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018
- 6. Hsu HC, Li X, Curtin JP, Goldberg JD, Schiff PB. Surveillance Epidemiology and End Results Analysis Demonstrates Improvement in Overall Survival for Cervical Cancer Patients Treated in the Era of Concurrent Chemoradiotherapy. Front Oncol. 2015; 5: 81.
- 7. Brisson M, Drolet M. Global elimination of cervical cancer as a public health problem. Lancet Oncol. 2019;20(3):319-321
- 8. Park KJ, Soslow RA. Current concepts in cervical pathology. Arch Pathol Lab Med. 2009;133(5): 729-738.
- 9. Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecologic oncology, 2010;116(1): 140-146.
- 10. Nakanishi T, Ishikawa H, Suzuki Y, et al. A comparison of prognoses of pathologic stage Ib adenocarcinoma and squamous cell carcinoma of the uterine cervix. Gynecol Oncol 2000;79:289–293.
- 11. Galic V, Herzog TJ, Lewin SN, et al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol 2012;125:287–291.
- 12. McIntyre JB, Wu JS, Craighead PS, et al. PIK3CA mutational status and overall survival in patients with cervical cancer treated with radical chemoradiotherapy. Gynecol Oncol 2012;128:409–414.
- 13. Takekuma M, Kasamatsu Y, Kado N, et al. The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I–II cervical cancer: A review. J Obstet Gynaecol Res. 2017;43(4): 617-626.
- 14. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1990;38(3): 352-357.
- 15. Endo D, Todo Y, Okamoto K, Minobe S, Kato H, Nishiyama N. Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort. J Gynecol Oncol. 2015;26(1): 12-18.
- 16. Park JW, Bae JW. Prognostic significance of positive lymph node number in early cervical cancer. Mol Clin Oncol. 2016;4(6): 1052-1056.
- 17. Shinohara S, Ochi T, Miyazaki T, et al. Histopathological prognostic factors in patients with cervical cancer treated with radical hysterectomy and postoperative radiotherapy. Int J Clin Oncol. 2004;9(6): 503-509.
- 18. Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579–1588.
- 19. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer. 2018;142(9):1952-1958.
Long-Term Follow-Up Outcomes of Cervical Cancer Patients: A Single Center Experience from the East Anatolian Region of Turkey
Öz
Objective: Cervical cancer (CC) is the 4th most common cause of
cancer-related deaths in women all over the world. The most important etiologic
cause is HPV, and this allows tumor to have high chance of curing with early
diagnosis by screening programs. However, information about long-term survival
data of CC is limited in our country. In our study; we wanted to reveal the survival
times of our patients with CC and the factors that predict these times.
Material and methods: Seventy-three patients
with CC, followed between
2000 and 2017 were analyzed retrospectively.
Associations between clinical and histopathological parameters with overall
survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-
Meier curves and compared by the log-rank test. Univariate and multivariate
analysis were used to assess their prognostic values for PFS and OS.
Results: The median age of the patients was 56 years. The most
common histological subtype was squamous cell carcinoma (79.5%) followed by
adenocarcinoma (16.4%).According to FIGO staging system, 31 (43.8%) of the
patients were diagnosed as stage 1-2 and 42 (56.2%) were as stage 3-4.The
median PFS and OS are 44 months and 78 months. The 5-year survival rate is
37.5% (12%-75%). Although there was no difference in length of life between
histological subtypes, both PFS and OS were longer in patients with good ECOG
performance score (0-1), early FIGO stage (1-2), tumor size <4 cm, and without
parametrial and lymph node involvement. Multivariate analysis showed that ECOG
performance score, parametrial involvement and lymph node involvement were
independent prognostic factors for PFS and OS.
Conclusion: The stage at time of
diagnosis of CC patients in our region is more advanced and their 5-year
survival rates are below the world average, so our women need to be better
informed about this subject.
Anahtar Kelimeler
Kaynakça
- 1. Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393(10167):169-182
- 2. Aydoğdu MGS, Özsoy Ü. Cervical cancer and HPV. Androl Bul 2018;20:25−29
- 3. Crosbie EJ, Einstein HM, Franceschi S, Kitchener CH. Human papillomavirus and cervical cancer. Lancet. 2013;382(9895):889-99
- 4. Zhao H, He Y, Yang S, Zhao Q, Wu YM. Neoadjuvant chemotherapy with radical surgery vs radical surgery alone for cervical cancer: a systematic review and meta-analysis. Onco Targets Ther. 2019;12:1881–1891
- 5. Noone AM, Howlader N, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018
- 6. Hsu HC, Li X, Curtin JP, Goldberg JD, Schiff PB. Surveillance Epidemiology and End Results Analysis Demonstrates Improvement in Overall Survival for Cervical Cancer Patients Treated in the Era of Concurrent Chemoradiotherapy. Front Oncol. 2015; 5: 81.
- 7. Brisson M, Drolet M. Global elimination of cervical cancer as a public health problem. Lancet Oncol. 2019;20(3):319-321
- 8. Park KJ, Soslow RA. Current concepts in cervical pathology. Arch Pathol Lab Med. 2009;133(5): 729-738.
- 9. Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecologic oncology, 2010;116(1): 140-146.
- 10. Nakanishi T, Ishikawa H, Suzuki Y, et al. A comparison of prognoses of pathologic stage Ib adenocarcinoma and squamous cell carcinoma of the uterine cervix. Gynecol Oncol 2000;79:289–293.
- 11. Galic V, Herzog TJ, Lewin SN, et al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol 2012;125:287–291.
- 12. McIntyre JB, Wu JS, Craighead PS, et al. PIK3CA mutational status and overall survival in patients with cervical cancer treated with radical chemoradiotherapy. Gynecol Oncol 2012;128:409–414.
- 13. Takekuma M, Kasamatsu Y, Kado N, et al. The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I–II cervical cancer: A review. J Obstet Gynaecol Res. 2017;43(4): 617-626.
- 14. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1990;38(3): 352-357.
- 15. Endo D, Todo Y, Okamoto K, Minobe S, Kato H, Nishiyama N. Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort. J Gynecol Oncol. 2015;26(1): 12-18.
- 16. Park JW, Bae JW. Prognostic significance of positive lymph node number in early cervical cancer. Mol Clin Oncol. 2016;4(6): 1052-1056.
- 17. Shinohara S, Ochi T, Miyazaki T, et al. Histopathological prognostic factors in patients with cervical cancer treated with radical hysterectomy and postoperative radiotherapy. Int J Clin Oncol. 2004;9(6): 503-509.
- 18. Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579–1588.
- 19. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer. 2018;142(9):1952-1958.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Aralık 2019 |
| Gönderilme Tarihi | 18 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 46 Sayı: 4 |