Nüks eden özofagus skuamöz hücreli karsinomunda aneminin prognostik etkisi

Abstract

Amaç: Bu çalışmanın amacı, özofagus skuamöz hücreli karsinom (ESCC) nedeniyle küratif tedavi almış ve takip sürecinde nüks gelişmiş hastalarda, nüks anındaki aneminin sağkalım ve prognoz üzerine etkisini değerlendirmektir. Gereç ve Yöntem: Definitif tedavi sonrası nüks gelişen 105 ESCC hastasının verileri retrospektif olarak incelendi. Hastalar, nüks anındaki hemoglobin düzeylerine göre laboratuvar referans aralıkları temel alınarak anemi ve anemi olmayan gruplara ayrıldı. Klinik özellikler, nüks paternleri ve nüks tedavileri gruplar arasında karşılaştırıldı. Sağkalım analizleri Kaplan–Meier yöntemiyle yapıldı; nüks sonrası mortaliteyi etkileyen faktörler Cox regresyon analizi ile değerlendirildi. Bulgular: Hastaların %60’ında nüks sırasında anemi saptandı. Anemik hastalar, anemi olmayanlara göre belirgin şekilde daha yaşlıydı (64,7 ± 4,9 vs. 58,3 ± 5,5 yıl; p<0,001) ve çoğunlukla ileri evrede tanı almıştı (evre III–IV: %93,6 vs. %19,0; p<0,001). Anemik grupta nükslerin büyük bölümü uzak metastatik veya kombine tipteyken, anemi olmayan grupta hastaların %88,1’i lokal nüksle başvurmuştu (p<0,001). Nüks sonrası sağkalım, anemi grubunda belirgin şekilde daha kötüydü; mortalite oranı anemik hastalarda %93,7 iken anemi olmayanlarda %64,3 idi (p<0,001). Sonuç: Özofagus kanseri nüksü sırasında anemi varlığı, daha ileri hastalık ve daha kötü sağkalım sonuçları ile ilişkilidir. Çok değişkenli analizde aneminin bağımsız bir prognostik faktör olmadığı görülse de, sistemik inflamasyon ve tümör yükünü yansıtan önemli bir belirteç olarak kötü prognozlu hastaların belirlenmesine yardımcı olabilir.

Keywords

• özofagus kanseri
• defintive tedavi
• nüks
• anemi
• sistemik inflamasyon

The prognostic impact of anemia in recurrent esophageal squamous cell carcinoma

Abstract

Aims: The aim of this study was to evaluate the impact of anemia at the time of recurrence on survival and prognosis in patients with esophageal squamous cell carcinoma (ESCC) who developed relapse during follow-up after definitive treatment. Methods: The data of 105 patients who had received definitive treatment for ESCC and subsequently developed recurrence were retrospectively reviewed. The mean age of the patients was 62.1±5.9 years (median 62), and 68.6% were male. Based on hemoglobin levels at the time of recurrence, patients were categorized into anemia and non-anemia groups according to laboratory reference ranges. Clinical characteristics, recurrence patterns, and treatments administered for recurrence were compared between the groups. Survival analyses were performed using the Kaplan–Meier method and the log-rank test; factors affecting post-recurrence mortality were evaluated with Cox regression analysis. Results: Anemia was detected in 60.0% of patients at the time of recurrence. Patients with anemia were significantly older than those without anemia (64.7±4.9 vs. 58.3±5.5 years, p<0.001) and more frequently had advanced disease at the initial diagnosis (stage III–IV: 93.6% vs. 19.0%, p<0.001). Most recurrences in the anemia group were distant metastatic or combined patterns, whereas 88.1% of the non-anemic group presented with localized recurrence (p<0.001). Post-recurrence survival was markedly worse in the anemic group: the mortality rate was 93.7% compared to 64.3% in the non-anemic group (p<0.001). However, in multivariate analysis, anemia was not an independent prognostic factor for mortality (p=0.149). Distant recurrence type (HR: 0.554, p=0.033) and palliative CT/RT as recurrence treatment (HR: 3.441, p<0.001) were identified as independent predictors. Conclusion: Although anemia at the time of recurrence in patients with esophageal cancer was not an independent prognostic factor, it is a prevalent finding that reflects more advanced disease and poorer survival outcomes. It may serve as a clinical marker of systemic inflammation and high tumor burden, helping to identify a patient subgroup with a worse prognosis.

Keywords

• Esophageal cancer
• definitive treatment
• recurrence
• anemia
• systemic inflammation

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