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Yaşlı Hastalarda Kolorektal Kanser Tanısında Serum Ferritin Düzeyinin Yeri

Yıl 2022, Cilt: 11 Sayı: 1, 77 - 83, 29.04.2022
https://doi.org/10.47493/abantmedj.837087

Öz

Amaç: Ferritin demir eksiklğinin bir belirtecidir. Kolorektal kanser yaşlı bireylerde önemli bir morbidite ve mortalite sebebidir. Bu çalışmnaın amacı yaşlı bireylerde serum ferritin ve ferritin-transferrin saturasyonunun kolorektal kanser tanısındaki yerini önemini belirlemektir.


Gereç ve Yöntemler:
Çalışmaya üst ve alt gastrointestinal endoskopi sonucu olan 65 yaş ve üstü 600 hasta alınmıştır. Serum demir profili ve C-reaktif protein değerleri incelenmiştir. Hastalar ferritin düzeylerine göre üç gruba ayrılmıştır: metod 1: ferritin < 50 µg/L; metod 2: ferritin < 100 µg/L; metod 3: ferritin+transferrin saturasyon indeksi. Her üç metod ile kolorektal kanser varlığı ile serum ferritin düzeyi arasındaki ilişki araştırılmıştır.


Bulgular:
528 hastanın üst ve alt gastrointestinal endoskopi bulguları normaldir. 72 hastada kolorektal kanser saptanırken, bu hastaların hepsinde üst gastrointestinal endoskopi bulguları normal olarak bulunmuştur. Metod 1 (ferritin<50 µg/L) kolorektal kanser varlığını %58.4 oranında tahmin etmiştir (Duyarlılık ve özgünlük sırasıyla %63 ve %53’tür). Buna karşın metod 3’ün duyarlılığı [91% (95% CI:82-96)] metod 1 ve 2’den daha yüksek olup AUROC değeri %70,4’tür. Her üç grupta da median ferritin düzeyleri arasında fark bulunamamıştır. Median transferrin saturasyon indeksi grup I’de (Normal hastalar) grup II’ye (Kolorektal kanserli hastalar) göre daha yüksektir (17.5 vs 8%, p<0.001).

Sonuç: Serum ferritin düzeyi <50 μg/L ve <100 μg/L değerlerinde kolonoskopik incelemeye karar vermekte düşük tanısal değere sahiptir. Buna karşılık serum ferritin düzeyi <100 μg/L ve transferrin saturasyon indeksi <%16 ise yaşlı bireylerde kolonoskopik incelemeye karar vermekte daha yararlı olarak bulunmuştur.

Kaynakça

  • 1. World Health Organization. WHO, Global Health and Aging. 2011. https://www.who.int/ageing/publications/global_health.pdf
  • 2. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and managment. Blood . 2018; 131(5): 505-514.
  • 3. Masson S, Chinn DJ, Tabaqchali MA, Waddup G, Dwarakanath AD. Is anaemia relevant in the referral and diagnosis of colorectal cancer? Colorectal Dis 2007; 9(8): 736– 739.
  • 4. Beale AL, Penney MD, Allison MC. The prevalence of iron deficiency among patients presenting with colorectal cancer. Colorectal Dis 2005; 7(4): 398– 402.
  • 5. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019; 394(10207) :1467-1480
  • 6. Joosten E, Meeuwissen J, Vandewinckele H, Hiele M. Iron status and colorectal cancer in symptomatic elderly patients. Am J Med 2008; 121(12): 1072 -1077.
  • 7. Guyatt G, Oxman A, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: An overview. J Gen Intern Med 1992; 7(2) :145– 153.
  • 8. Guyatt GH, Patterson C, Ali M, et al. Diagnosis of iron deficiency anemia in the elderly. Am J Med 1990; 88(3): 205– 209.
  • 9. Wilcox CM, Alexander LN, Clark WS. Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs. Am J Med 1997; 103(5): 405– 409.
  • 10. Lee JG, Sahagun G, Oehlke MA, Lieberman DA. Serious gastrointestinal pathology found in patients with serum ferritin values < 50 ng/ml. Am J Gastroenterol 1998; 93(5): 772– 776.
  • 11. Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron deficiency anemia. N Engl J Med 1993; 329(23): 1691– 1695.
  • 12. Ioannou GN. Spector J. Scott K. Rockey DC. Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia. Am J Med 2002; 113(4): 281– 287.
  • 13. Joosten E, Ghesquiere B, Linthoudt H, et al. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med 1999; 107(1): 24– 29.
  • 14. Snozek CLH, Spears GM, Porco AB, Erb S, Kaleta EJ, Bryant SC, Baumann NA. Updated ferritin reference intervals for the Roche Elecsys® immunoassay Clin Biochem. 2021; 87: 100-103
  • 15. Ambrosy AP, Fitzpatrick JK, Tabada GH, Gurwitz JH, Artz A, Schrier SL, Rao SV, et al. RBC HEART Investigators/PACTTE Consortium. A reduced transferrin saturation is independently associated with excess morbidity and mortality in older adults with heart failure and incident anemia. Int J Cardiol. 2020; 309:95-99
  • 16. Mukhopadhyay D, Mohanaruban K. Iron deficiency anaemia in older people: investigation, management and treatment. Age Ageing 2002; 31(2): 87– 91.
  • 17. Holyoake TL, Stott DJ, McKay PJ, Hendry A, MacDonald JB, Lucie NP. Use of plasma ferritin concentration to diagnose iron deficiency in elderly patients. J Clin Pathol 1993; 46(9): 857– 860.
  • 18. Hansen TM, Hansen NE, Birgens HS, Holund B, Lorenzen I. Serum ferritin and the assessment of iron deficiency in rheumatoid arthritis. Scand J Rheumatol 1983; 12(4): 353– 359.
  • 19. Bell H, Skinningsrud A, Raknerud N, Try K. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non-alcoholic liver diseases. J Intern Med 1994; 236(3): 315– 322.
  • 20. Bentley D, Williams P. Serum ferritin concentration as an index of storage iron in rheumatoid arthritis. J Clin Pathol 1974; 27(10): 786– 788.
  • 21. Krause J, Stolc V. Serum ferritin and bone marrow biopsy iron stores. II. Correlation with low serum iron and Fe/TIBC ratio less than 15 %. Am J Clin Pathol 1980; 74(4): 461- 464.
  • 22. Sawhney MS, Lipato T, Nelson DB, Lederle FA, Rector TS, Bond JH. Should patients with anemia and low normal or normal serum ferritin undergo colonoscopy? Am J Gastroenterol 2007; 102(1): 82- 88.
  • 23. U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, et al. Screening for colorectal cancer : US Preventive Services Task Force recommendation statement. JAMA 2016; 315(23): 2564 - 2575.
  • 24. Qaseem A, Denberg TD, Hopkins RH Jr, Humphrey R, Levine J, Sweet DE, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med 2012; 156(5): 378- 386.
  • 25. Nelson RL. Elevation of serum ferritin is superior to fecal occult blood testing as a sc.reening test for colonic adenoma, and not only because patients do not have to handle their own stool [letter]. Dis Colon Rectum 1996; 39(12): 1441- 1442.
  • 26. Scholefield JH, Robinson MH, Bostock K, Brown NS. Serum ferritin. Screening test for colorectal cancer? Dis Colon Rectum 1998; 41(8): 1029 -1031.
  • 27. Ho C-H, Yu Y-B, Wu P-H. The prevalence of iron deficiency anemia and its clinical implications in patients with colorectal carcinoma. J Chin Med Assoc 2008; 71(3): 119– 122.
  • 28. Coban E, Timuragaoglu A, Meriç M. Iron deficiency anemia in the elderly: prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Acta Haematol 2003; 110(1): 25- 28.
  • 29. Tingting H, Di S, Xiaoping C, Xiaohong W, Dong H. High preoperative serum ferritin predicted poor prognosis in non-metastatic colorectal cancer. Saudi Med J. 2017; 38(3):268-275
  • 30. Matzner Y, Konijin AM, Hershko C. Serum ferritin in hematologic malignancies. Am J Hematol 1980; 9(1): 13– 22.

Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients

Yıl 2022, Cilt: 11 Sayı: 1, 77 - 83, 29.04.2022
https://doi.org/10.47493/abantmedj.837087

Öz

Objective: Ferritin is an indicator of iron deficiency. Colorectal cancer is an important cause of morbidity and mortality in older subjects. The aim of this study was to determine the value of serum ferritin and ferritin-transferrin saturation in the diagnosis of colorectal cancer in older subjects.

Material and Methods: 600 older patients who had undergone upper and lower gastrointestinal endoscopic examination were included into the study. Serum iron profile and C-reactive protein were also recorded. Patients were then evaluated by three different ferritin levels according to their iron profiles: method 1: ferritin < 50 µg/L; method 2: ferritin < 100 µg/L; method 3: ferritin+transferrin saturation index. The relationship between existence of colorectal cancer and serum ferritin level was investigated.


Results:
528 patients had normal upper and lower endoscopic findings. 72 patients had colorectal carcinoma with normal upper gastrointestinal findings. Method 1 (ferritin<50 µg/L) predicted 58.4% of patients with colorectal carcinoma with a sensitivity and specificity of 63% (95% CI:52-74) and 53% (95% CI: 48-57) respectively. However, sensitivity [91% (95% CI:82-96)] of method 3 was greater than method 1 and 2 with a AUROC value of 70.4%. There was no difference by means of median ferritin levels. Median transferrin saturation index was significantly higher in group I (Normal subjects) compared to patients in group II (Colorectal cancer patients) (17.5 vs 8%, p<0.001).

Conclusion: Serum ferritin <50 μg/L and <100 μg/L have rather low diagnostic yield in the decision making of colonscopic examination for colorectal carcinoma. However, ferritin <100 μg/L and TSI <16% values can be more useful in selecting older patients for colonoscopic examination.

Kaynakça

  • 1. World Health Organization. WHO, Global Health and Aging. 2011. https://www.who.int/ageing/publications/global_health.pdf
  • 2. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and managment. Blood . 2018; 131(5): 505-514.
  • 3. Masson S, Chinn DJ, Tabaqchali MA, Waddup G, Dwarakanath AD. Is anaemia relevant in the referral and diagnosis of colorectal cancer? Colorectal Dis 2007; 9(8): 736– 739.
  • 4. Beale AL, Penney MD, Allison MC. The prevalence of iron deficiency among patients presenting with colorectal cancer. Colorectal Dis 2005; 7(4): 398– 402.
  • 5. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019; 394(10207) :1467-1480
  • 6. Joosten E, Meeuwissen J, Vandewinckele H, Hiele M. Iron status and colorectal cancer in symptomatic elderly patients. Am J Med 2008; 121(12): 1072 -1077.
  • 7. Guyatt G, Oxman A, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: An overview. J Gen Intern Med 1992; 7(2) :145– 153.
  • 8. Guyatt GH, Patterson C, Ali M, et al. Diagnosis of iron deficiency anemia in the elderly. Am J Med 1990; 88(3): 205– 209.
  • 9. Wilcox CM, Alexander LN, Clark WS. Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs. Am J Med 1997; 103(5): 405– 409.
  • 10. Lee JG, Sahagun G, Oehlke MA, Lieberman DA. Serious gastrointestinal pathology found in patients with serum ferritin values < 50 ng/ml. Am J Gastroenterol 1998; 93(5): 772– 776.
  • 11. Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron deficiency anemia. N Engl J Med 1993; 329(23): 1691– 1695.
  • 12. Ioannou GN. Spector J. Scott K. Rockey DC. Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia. Am J Med 2002; 113(4): 281– 287.
  • 13. Joosten E, Ghesquiere B, Linthoudt H, et al. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med 1999; 107(1): 24– 29.
  • 14. Snozek CLH, Spears GM, Porco AB, Erb S, Kaleta EJ, Bryant SC, Baumann NA. Updated ferritin reference intervals for the Roche Elecsys® immunoassay Clin Biochem. 2021; 87: 100-103
  • 15. Ambrosy AP, Fitzpatrick JK, Tabada GH, Gurwitz JH, Artz A, Schrier SL, Rao SV, et al. RBC HEART Investigators/PACTTE Consortium. A reduced transferrin saturation is independently associated with excess morbidity and mortality in older adults with heart failure and incident anemia. Int J Cardiol. 2020; 309:95-99
  • 16. Mukhopadhyay D, Mohanaruban K. Iron deficiency anaemia in older people: investigation, management and treatment. Age Ageing 2002; 31(2): 87– 91.
  • 17. Holyoake TL, Stott DJ, McKay PJ, Hendry A, MacDonald JB, Lucie NP. Use of plasma ferritin concentration to diagnose iron deficiency in elderly patients. J Clin Pathol 1993; 46(9): 857– 860.
  • 18. Hansen TM, Hansen NE, Birgens HS, Holund B, Lorenzen I. Serum ferritin and the assessment of iron deficiency in rheumatoid arthritis. Scand J Rheumatol 1983; 12(4): 353– 359.
  • 19. Bell H, Skinningsrud A, Raknerud N, Try K. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non-alcoholic liver diseases. J Intern Med 1994; 236(3): 315– 322.
  • 20. Bentley D, Williams P. Serum ferritin concentration as an index of storage iron in rheumatoid arthritis. J Clin Pathol 1974; 27(10): 786– 788.
  • 21. Krause J, Stolc V. Serum ferritin and bone marrow biopsy iron stores. II. Correlation with low serum iron and Fe/TIBC ratio less than 15 %. Am J Clin Pathol 1980; 74(4): 461- 464.
  • 22. Sawhney MS, Lipato T, Nelson DB, Lederle FA, Rector TS, Bond JH. Should patients with anemia and low normal or normal serum ferritin undergo colonoscopy? Am J Gastroenterol 2007; 102(1): 82- 88.
  • 23. U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, et al. Screening for colorectal cancer : US Preventive Services Task Force recommendation statement. JAMA 2016; 315(23): 2564 - 2575.
  • 24. Qaseem A, Denberg TD, Hopkins RH Jr, Humphrey R, Levine J, Sweet DE, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med 2012; 156(5): 378- 386.
  • 25. Nelson RL. Elevation of serum ferritin is superior to fecal occult blood testing as a sc.reening test for colonic adenoma, and not only because patients do not have to handle their own stool [letter]. Dis Colon Rectum 1996; 39(12): 1441- 1442.
  • 26. Scholefield JH, Robinson MH, Bostock K, Brown NS. Serum ferritin. Screening test for colorectal cancer? Dis Colon Rectum 1998; 41(8): 1029 -1031.
  • 27. Ho C-H, Yu Y-B, Wu P-H. The prevalence of iron deficiency anemia and its clinical implications in patients with colorectal carcinoma. J Chin Med Assoc 2008; 71(3): 119– 122.
  • 28. Coban E, Timuragaoglu A, Meriç M. Iron deficiency anemia in the elderly: prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Acta Haematol 2003; 110(1): 25- 28.
  • 29. Tingting H, Di S, Xiaoping C, Xiaohong W, Dong H. High preoperative serum ferritin predicted poor prognosis in non-metastatic colorectal cancer. Saudi Med J. 2017; 38(3):268-275
  • 30. Matzner Y, Konijin AM, Hershko C. Serum ferritin in hematologic malignancies. Am J Hematol 1980; 9(1): 13– 22.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Fatih Karakaya 0000-0001-5677-5532

İrfan Soykan 0000-0002-5971-4361

Erken Görünüm Tarihi 26 Nisan 2022
Yayımlanma Tarihi 29 Nisan 2022
Gönderilme Tarihi 7 Aralık 2020
Yayımlandığı Sayı Yıl 2022 Cilt: 11 Sayı: 1

Kaynak Göster

APA Karakaya, F., & Soykan, İ. (2022). Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients. Abant Tıp Dergisi, 11(1), 77-83. https://doi.org/10.47493/abantmedj.837087
AMA Karakaya F, Soykan İ. Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients. Abant Med J. Nisan 2022;11(1):77-83. doi:10.47493/abantmedj.837087
Chicago Karakaya, Fatih, ve İrfan Soykan. “Utility of Serum Ferritin As A Predictor of Colorectal Cancer in Elderly Patients”. Abant Tıp Dergisi 11, sy. 1 (Nisan 2022): 77-83. https://doi.org/10.47493/abantmedj.837087.
EndNote Karakaya F, Soykan İ (01 Nisan 2022) Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients. Abant Tıp Dergisi 11 1 77–83.
IEEE F. Karakaya ve İ. Soykan, “Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients”, Abant Med J, c. 11, sy. 1, ss. 77–83, 2022, doi: 10.47493/abantmedj.837087.
ISNAD Karakaya, Fatih - Soykan, İrfan. “Utility of Serum Ferritin As A Predictor of Colorectal Cancer in Elderly Patients”. Abant Tıp Dergisi 11/1 (Nisan 2022), 77-83. https://doi.org/10.47493/abantmedj.837087.
JAMA Karakaya F, Soykan İ. Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients. Abant Med J. 2022;11:77–83.
MLA Karakaya, Fatih ve İrfan Soykan. “Utility of Serum Ferritin As A Predictor of Colorectal Cancer in Elderly Patients”. Abant Tıp Dergisi, c. 11, sy. 1, 2022, ss. 77-83, doi:10.47493/abantmedj.837087.
Vancouver Karakaya F, Soykan İ. Utility of Serum Ferritin as A Predictor of Colorectal Cancer in Elderly Patients. Abant Med J. 2022;11(1):77-83.