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Kolorektal adenoma ve karsinomlu hastalarda metabolik ve inflamatuvar risk faktörlerinin değerlendirilmesi

Yıl 2022, Cilt: 21 Sayı: 3, 115 - 125, 29.12.2022
https://doi.org/10.17941/agd.1150314

Öz

Giriş ve Amaç: Metabolik sendrom ve ilişkili bileşenlerinin, hiperinsülinemi, insülin direnci ve kronik düşük dereceli inflamasyonla sonuçlanan oksidatif strese bağlı kolorektal neoplazmların gelişimi için risk faktörleri olduğu düşünülmektedir. Bu çalışma, kolorektal neoplazmların (kolon adenokarsinom ve kolon adenomu) metabolik sendrom bileşenleri, non-alkolik yağlı karaciğer hastalığı ve inflamatuvar belirteçlerle ilişkisini açıklamayı amaçlamaktadır. Gereç ve Yöntem: Kolon adenoma ve kolorektal adenokarsinom tanısı alan 151 hastanın verileri geriye dönük olarak incelendi. Demografik özellikler, rutin kan tetkikleri, kolonoskopik bulgular, patoloji sonuçları, kolorektal kanserin tümör-lenf nodu-metastaz evreleri ve hepatik ultrasonografi bulguları kaydedildi. İnsülin direnç testi skorları hesaplandı. Bulgular: Çalışma kohortu, kolorektal adenoma olan 71 hasta ve kolorektal kanseri olan 80 hastadan oluşuyordu. Diabetes mellitus, hipertansiyon, hipertrigliseridemi, metabolik sendrom, şiddetli karaciğer yağlanması olan hasta sayısı adenoma grubuna göre kolorektal kanser grubunda anlamlı olarak daha yüksekti. Ek olarak, nötrofil-lenfosit oranı, C-reaktif protein ve C-reaktif protein/albümin oranı, kolorektal adenoma grubuna göre, kolorektal kanser grubunda anlamlı olarak daha yüksekti. Tek değişkenli analizde diabetes mellitus, hipertansiyon, hipertrigliseridemi, metabolik sendrom, şiddetli karaciğer steatozu olan hastaların, bu risk faktörlerine sahip olmayanlara göre daha kısa sağkalım süresine sahip oldukları bulundu. Çok değişkenli analizde, ileri tümör-lenf nodu-metastaz evresi, şiddetli hepatosteatoz, hipertansiyon ve hipertrigliseridemi, kolorektal adenokanserli hastaların sağkalımı için bağımsız risk faktörleri olarak bulundu. Sonuç: Metabolik sendrom, ciddi karaciğer yağlanması ve inflamatuvar süreç, kolorektal kanser hastalarında, kolon adenomundan adenokarsinoma geçiş ve daha kısa sağkalım için risk faktörleri olabilir.

Kaynakça

  • 1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
  • 2. Lin X, You F, Liu H, et al. Site-specific risk of colorectal neoplasms in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. PloS One 2021;16:e0245921.
  • 3. Zhu B, Wu X, Wu B, et al. The relationship between diabetes and colorectal cancer prognosis: A meta-analysis based on cohort studies. PLoS One 2017;12:e0176068.
  • 4. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5.
  • 5. Harvey AE, Lashinger LM, Hursting SD. The growing challenge of obesity and cancer: an inflammatoryissue. Ann N Y Acad Sci 2011;1229:45-52.
  • 6. Jinjuvadia R, Lohia P, Jinjuvadia C, Montoya S, Liangpunsakul S. The association between metabolic syndrome and colorectal neoplasm: systemic review and meta-analysis. J Clin Gastroenterol 2013;47:33-44.
  • 7. Bowers K, Albanes D, Limburg P, et al. A prospective study of anthropometric and clinical measurements associated with insulin resistance syndrome and colorectal cancer in male smokers. Am J Epidemiol 2006;164:652-64.
  • 8. Stocks T, Lukanova A, Bjørge T,et al; Metabolic Syndrome Cancer Project Me-Can Group. Metabolic factors and the risk of colorectal cancer in 580,000 men and women in the metabolic syndrome and cancer project (Me-Can). Cancer 2011;117:2398-407.
  • 9. Tsilidis KK, Brancati FL, Pollak MN, et al. Metabolic syndrome components and colorectal adenoma in the CLUE II cohort. Cancer Causes Control 2010;21:1-10.
  • 10. Aleksandrova K, Boeing H, Jenab M, et al. Metabolic syndrome and risks of colon and rectal cancer: The European prospective investigation into cancer and nutrition study. Cancer Prev Res 2011;4:1873-83.
  • 11. Ferraioli G, Monteiro LBS. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol 2019;25:6053-62.
  • 12. Brown GT, Kleiner DE. Histopathology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Metabolism 2016;65:1080-6.
  • 13. Becker DJ, Iyengar AD, Punekar SR, et al. Diabetes mellitus and colorectal carcinoma outcomes: a meta-analysis. Int J Colorectal Dis 2020;35:1989-99.
  • 14. Wu L, Yu C, Jiang H, et al. Diabetes mellitus and the occurrence of colorectal cancer: an updated meta-analysis of cohort studies. Diabetes Technol Ther 2013;15:419-27.
  • 15. Guraya SY. Association of type 2 diabetes mellitus and the risk of colorectal cancer: A meta-analysis and systematic review. World J Gastroenterol 2015;21:6026-31.
  • 16. Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PloS one 2013;8:e53916.
  • 17. Aleksandrova K, Nimptsch K, Pischon T. Obesity and colorectal cancer. Front Biosci (Elite Ed) 2013;5:61-77.
  • 18. Dong Y, Zhou J, Zhu Y, et al. Abdominal obesity and colorectal cancer risk: systematic review and meta-analysis of prospective studies. Biosci Rep 2017;37:BSR20170945.
  • 19. Joshi RK, Lee SA. Obesity-related adipokines and colorectal cancer: a review and meta-analysis. Asian Pac J Cancer Prev 2014;15:397-405.
  • 20. Seretis A, Cividini S, Markozannes G, et al. Association between blood pressure and risk of cancer development: a systematic review and meta-analysis of observational studies. Sci Rep 2019;9:8565.
  • 21. Esposito K, Chiodini P, Capuano A, et al. Colorectal cancer association with metabolic syndrome and its components: a systematic review with meta-analysis. Endocrine 2013;44:634-47.
  • 22. Ahmed RL, Schmitz KH, Anderson KE, et al. The metabolic syndrome and risk of incident colorectal cancer. Cancer 2006;107:28-36.
  • 23. Chiu HM, Lin JT, Shun CT, et al. Association of metabolic syndrome with proximal and synchronous colorectal neoplasm. Clinical gastroenterology and hepatology : the official clinical practice. Clin Gastroenterol Hepatol 2007;5:221-9.
  • 24. Kim BC, SHiN A, Hong CW, et al. Association of colorectal adenoma with components of metabolic syndrome. Cancer Causes Control 2012;23:727-35.
  • 25. Morita T, Tabata S, Mineshita M. The metabolic syndrome is associated with increased risk of colorectal adenoma development: the Self-Defense Forces health study. Asian Pac J Cancer Prev 2005;6:485-9.
  • 26. Steinbach G, Kumar SP, Reddy BS, Lipkin M, Holt PR. Effects of caloric restriction and dietary fat on epithelial cell proliferation in rat colon. Cancer Res 1993;53:2745-9.
  • 27. Shen X, Wang Y, Zhao R, et al. Metabolic syndrome and the risk of colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021;36:2215-25.
  • 28. Coppola JA, Shrubsole MJ, Cai Q, et al. Plasma lipid levels and colorectal adenoma risk. Cancer Causes Control 2015;26:635-43.
  • 29. Passarelli MN, Newcomb PA. Blood lipid concentrations and colorectal adenomas: A systematic review and meta-analysis of colonoscopy studies in Asia, 2000-2014. Am J Epidemiol 2016;183:691-700.
  • 30. Fang Z, He M, Song M. Serum lipid profiles and risk of colorectal cancer: a prospective cohort study in the UK Biobank. Br J Cancer 2021;124:663-70.
  • 31. Yao X, Tian Z. Dyslipidemia and colorectal cancer risk: a meta-analysis of prospective studies. Cancer Causes Control  2015;26:257-68.
  • 32. Van Duijnhoven FJ, Bueno-De-Mesquita HB, Calligaro M, et al. Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Gut 2011;60:1094-102.
  • 33. Agnoli C, Grioni S, Sieri S, et al. Colorectal cancer risk and dyslipidemia: a case-cohort study nested in an Italian multicentre cohort. Cancer Epidemiol 2014;38:144-51.
  • 34. Pakiet A, Kobiela J, Stepnowski P, Sledzinski T, Mika A. Changes in lipids composition and metabolism in colorectal cancer: a review. Lipids Health Dis 2019;18:29.
  • 35. Kigawa N, Budhathoki S, Yamaji T, et al. Association of plasma C-reactive protein level with the prevalence of colorectal adenoma: the Colorectal Adenoma Study in Tokyo. Sci Rep 2017;7:4456.
  • 36. Liao CK, Yu YL, Lin YC, et al. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis. World J Surg Oncol 2021;19:139.
  • 37. Zhou B, Shu B, Yang J, et al. C-reactive protein, interleukin-6 and the risk of colorectal cancer: a meta-analysis. Cancer Causes Control 2014;25:1397-405.
  • 38. Li MX, Liu XM, Zhang XF, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review and meta-analysis. Int J Cancer 2014;134:2403-13.
  • 39. Kang W, Lee S, Jeon E, et al. Emerging role of vitamin D in colorectal cancer. World J Gastrointest Oncol 2011;3:123-7.
  • 40. Zhang L, Zou H, Zhao Y, et al. Association between blood circulating vitamin D and colorectal cancer risk in Asian countries: a systematic review and dose-response meta-analysis. BMJ Open 2019;9:e030513.
  • 41. Wu G, Xue M, Zhao Y, et al. Low circulating 25-hydroxyvitamin D level is associated with increased colorectal cancer mortality: a systematic review and dose-response meta-analysis. Biosci Rep 2020;40:BSR20201008.
  • 42. Chen J, Bian D, Zang S, et al. The association between nonalcoholic fatty liver disease and risk of colorectal adenoma and cancer incident and recurrence: a meta-analysis of observational studies. Expert Rev Gastroenterol Hepatol 2019;13:385-95.
  • 43. Wu K, Zhai MZ, Weltzien EK, et al. Non-alcoholic fatty liver disease and colorectal cancer survival. Cancer Causes Control 2019;30:165-8.
  • 44. Chung KH, Park MJ, Jin EH, et al. Risk factors for high-risk adenoma on the first lifetime colonoscopy using decision tree method: A cross-sectional study in 6,047 asymptomatic Koreans. Front Med (Lausanne) 2021;8:719768.
  • 45. Qaseem A, Crandall Cj, Mustafa Ra, et al. Screening for colorectal cancer in asymptomatic average risk adults: A guidance statement from the American College of Physicians. Ann Intern Med 2019;171:643-54.
  • 46. Tao S, Hoffmeister M, Brenner H. Development and validation of a scoring system to identify individuals at high risk for advanced colorectal neoplasms who should undergo colonoscopy screening. Clin Gastroenterol Hepatol 2014;12:478-85.
  • 47. Pelucchi C, Negri E, Talamini R, et al. Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer 2010;46:1866-72.

Assessment of metabolic and inflammatory risk factors in patients with colorectal adenoma and carcinoma

Yıl 2022, Cilt: 21 Sayı: 3, 115 - 125, 29.12.2022
https://doi.org/10.17941/agd.1150314

Öz

Background and Aims: Metabolic syndrome and its related components are thought to be risk factors for developing colorectal neoplasms due to hyperinsulinemia, insulin resistance, and oxidative stress resulting in chronic low-grade inflammation. This study aims to explain the association of colorectal neoplasms (colon adenocarcinoma and colon adenoma) with metabolic syndrome components, non-alcoholic fatty liver disease, and inflammatory markers. Materials and Methods: Data of 151 patients diagnosed with colon adenoma and colorectal adenocarcinoma were retrospectively reviewed. Demographic characteristics, routine blood tests, colonoscopic findings, pathology results, tumor-node-metastasis stages of colorectal adenocancer, and hepatic ultrasonography findings were recorded. The Homeostatic Model Assessment for Insulin Resistance scores were calculated. Results: The study cohort consisted of 71 patients with adenoma and 80 patients with colorectal adenocancer. The number of patients with diabetes mellitus, hypertension, hypertriglyceridemia, metabolic syndrome, severe liver steatosis was significantly higher in the colorectal adenocancer group compared to the colorectal adenoma group. Additionally, neutrophil-lymphocyte ratio, C-reactive protein, and C-reactive protein to albumin ratio were significantly higher in the colorectal adenocancer group compared to the adenoma group. In univariant analysis, patients with diabetes mellitus, hypertension, hypertriglyceridemia, metabolic syndrome, severe liver steatosis were found to have a shorter duration of survival than those who did not have these risk factors. In multivariate analysis, advanced tumor-node-metastasis stage, severe hepatosteatosis, hypertension, and hypertriglyceridemia were found to be independent risk factors for survival of the patients with colorectal adenocancer. Conclusions: Metabolic syndrome, severe liver steatosis, and inflammatory process may be risk factors for the transition from colon adenoma to adenocarcinoma and shorter survival in colorectal cancer patients.

Kaynakça

  • 1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
  • 2. Lin X, You F, Liu H, et al. Site-specific risk of colorectal neoplasms in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. PloS One 2021;16:e0245921.
  • 3. Zhu B, Wu X, Wu B, et al. The relationship between diabetes and colorectal cancer prognosis: A meta-analysis based on cohort studies. PLoS One 2017;12:e0176068.
  • 4. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5.
  • 5. Harvey AE, Lashinger LM, Hursting SD. The growing challenge of obesity and cancer: an inflammatoryissue. Ann N Y Acad Sci 2011;1229:45-52.
  • 6. Jinjuvadia R, Lohia P, Jinjuvadia C, Montoya S, Liangpunsakul S. The association between metabolic syndrome and colorectal neoplasm: systemic review and meta-analysis. J Clin Gastroenterol 2013;47:33-44.
  • 7. Bowers K, Albanes D, Limburg P, et al. A prospective study of anthropometric and clinical measurements associated with insulin resistance syndrome and colorectal cancer in male smokers. Am J Epidemiol 2006;164:652-64.
  • 8. Stocks T, Lukanova A, Bjørge T,et al; Metabolic Syndrome Cancer Project Me-Can Group. Metabolic factors and the risk of colorectal cancer in 580,000 men and women in the metabolic syndrome and cancer project (Me-Can). Cancer 2011;117:2398-407.
  • 9. Tsilidis KK, Brancati FL, Pollak MN, et al. Metabolic syndrome components and colorectal adenoma in the CLUE II cohort. Cancer Causes Control 2010;21:1-10.
  • 10. Aleksandrova K, Boeing H, Jenab M, et al. Metabolic syndrome and risks of colon and rectal cancer: The European prospective investigation into cancer and nutrition study. Cancer Prev Res 2011;4:1873-83.
  • 11. Ferraioli G, Monteiro LBS. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol 2019;25:6053-62.
  • 12. Brown GT, Kleiner DE. Histopathology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Metabolism 2016;65:1080-6.
  • 13. Becker DJ, Iyengar AD, Punekar SR, et al. Diabetes mellitus and colorectal carcinoma outcomes: a meta-analysis. Int J Colorectal Dis 2020;35:1989-99.
  • 14. Wu L, Yu C, Jiang H, et al. Diabetes mellitus and the occurrence of colorectal cancer: an updated meta-analysis of cohort studies. Diabetes Technol Ther 2013;15:419-27.
  • 15. Guraya SY. Association of type 2 diabetes mellitus and the risk of colorectal cancer: A meta-analysis and systematic review. World J Gastroenterol 2015;21:6026-31.
  • 16. Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PloS one 2013;8:e53916.
  • 17. Aleksandrova K, Nimptsch K, Pischon T. Obesity and colorectal cancer. Front Biosci (Elite Ed) 2013;5:61-77.
  • 18. Dong Y, Zhou J, Zhu Y, et al. Abdominal obesity and colorectal cancer risk: systematic review and meta-analysis of prospective studies. Biosci Rep 2017;37:BSR20170945.
  • 19. Joshi RK, Lee SA. Obesity-related adipokines and colorectal cancer: a review and meta-analysis. Asian Pac J Cancer Prev 2014;15:397-405.
  • 20. Seretis A, Cividini S, Markozannes G, et al. Association between blood pressure and risk of cancer development: a systematic review and meta-analysis of observational studies. Sci Rep 2019;9:8565.
  • 21. Esposito K, Chiodini P, Capuano A, et al. Colorectal cancer association with metabolic syndrome and its components: a systematic review with meta-analysis. Endocrine 2013;44:634-47.
  • 22. Ahmed RL, Schmitz KH, Anderson KE, et al. The metabolic syndrome and risk of incident colorectal cancer. Cancer 2006;107:28-36.
  • 23. Chiu HM, Lin JT, Shun CT, et al. Association of metabolic syndrome with proximal and synchronous colorectal neoplasm. Clinical gastroenterology and hepatology : the official clinical practice. Clin Gastroenterol Hepatol 2007;5:221-9.
  • 24. Kim BC, SHiN A, Hong CW, et al. Association of colorectal adenoma with components of metabolic syndrome. Cancer Causes Control 2012;23:727-35.
  • 25. Morita T, Tabata S, Mineshita M. The metabolic syndrome is associated with increased risk of colorectal adenoma development: the Self-Defense Forces health study. Asian Pac J Cancer Prev 2005;6:485-9.
  • 26. Steinbach G, Kumar SP, Reddy BS, Lipkin M, Holt PR. Effects of caloric restriction and dietary fat on epithelial cell proliferation in rat colon. Cancer Res 1993;53:2745-9.
  • 27. Shen X, Wang Y, Zhao R, et al. Metabolic syndrome and the risk of colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021;36:2215-25.
  • 28. Coppola JA, Shrubsole MJ, Cai Q, et al. Plasma lipid levels and colorectal adenoma risk. Cancer Causes Control 2015;26:635-43.
  • 29. Passarelli MN, Newcomb PA. Blood lipid concentrations and colorectal adenomas: A systematic review and meta-analysis of colonoscopy studies in Asia, 2000-2014. Am J Epidemiol 2016;183:691-700.
  • 30. Fang Z, He M, Song M. Serum lipid profiles and risk of colorectal cancer: a prospective cohort study in the UK Biobank. Br J Cancer 2021;124:663-70.
  • 31. Yao X, Tian Z. Dyslipidemia and colorectal cancer risk: a meta-analysis of prospective studies. Cancer Causes Control  2015;26:257-68.
  • 32. Van Duijnhoven FJ, Bueno-De-Mesquita HB, Calligaro M, et al. Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Gut 2011;60:1094-102.
  • 33. Agnoli C, Grioni S, Sieri S, et al. Colorectal cancer risk and dyslipidemia: a case-cohort study nested in an Italian multicentre cohort. Cancer Epidemiol 2014;38:144-51.
  • 34. Pakiet A, Kobiela J, Stepnowski P, Sledzinski T, Mika A. Changes in lipids composition and metabolism in colorectal cancer: a review. Lipids Health Dis 2019;18:29.
  • 35. Kigawa N, Budhathoki S, Yamaji T, et al. Association of plasma C-reactive protein level with the prevalence of colorectal adenoma: the Colorectal Adenoma Study in Tokyo. Sci Rep 2017;7:4456.
  • 36. Liao CK, Yu YL, Lin YC, et al. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis. World J Surg Oncol 2021;19:139.
  • 37. Zhou B, Shu B, Yang J, et al. C-reactive protein, interleukin-6 and the risk of colorectal cancer: a meta-analysis. Cancer Causes Control 2014;25:1397-405.
  • 38. Li MX, Liu XM, Zhang XF, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review and meta-analysis. Int J Cancer 2014;134:2403-13.
  • 39. Kang W, Lee S, Jeon E, et al. Emerging role of vitamin D in colorectal cancer. World J Gastrointest Oncol 2011;3:123-7.
  • 40. Zhang L, Zou H, Zhao Y, et al. Association between blood circulating vitamin D and colorectal cancer risk in Asian countries: a systematic review and dose-response meta-analysis. BMJ Open 2019;9:e030513.
  • 41. Wu G, Xue M, Zhao Y, et al. Low circulating 25-hydroxyvitamin D level is associated with increased colorectal cancer mortality: a systematic review and dose-response meta-analysis. Biosci Rep 2020;40:BSR20201008.
  • 42. Chen J, Bian D, Zang S, et al. The association between nonalcoholic fatty liver disease and risk of colorectal adenoma and cancer incident and recurrence: a meta-analysis of observational studies. Expert Rev Gastroenterol Hepatol 2019;13:385-95.
  • 43. Wu K, Zhai MZ, Weltzien EK, et al. Non-alcoholic fatty liver disease and colorectal cancer survival. Cancer Causes Control 2019;30:165-8.
  • 44. Chung KH, Park MJ, Jin EH, et al. Risk factors for high-risk adenoma on the first lifetime colonoscopy using decision tree method: A cross-sectional study in 6,047 asymptomatic Koreans. Front Med (Lausanne) 2021;8:719768.
  • 45. Qaseem A, Crandall Cj, Mustafa Ra, et al. Screening for colorectal cancer in asymptomatic average risk adults: A guidance statement from the American College of Physicians. Ann Intern Med 2019;171:643-54.
  • 46. Tao S, Hoffmeister M, Brenner H. Development and validation of a scoring system to identify individuals at high risk for advanced colorectal neoplasms who should undergo colonoscopy screening. Clin Gastroenterol Hepatol 2014;12:478-85.
  • 47. Pelucchi C, Negri E, Talamini R, et al. Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer 2010;46:1866-72.
Toplam 47 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Ezgi Karahan Bu kişi benim 0000-0002-1661-933X

Zeynep Gök Sargın Bu kişi benim 0000-0001-9193-4105

Yücel Üstündağ Bu kişi benim 0000-0002-6442-1619

Yayımlanma Tarihi 29 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 21 Sayı: 3

Kaynak Göster

APA Karahan, E., Gök Sargın, Z., & Üstündağ, Y. (2022). Assessment of metabolic and inflammatory risk factors in patients with colorectal adenoma and carcinoma. Akademik Gastroenteroloji Dergisi, 21(3), 115-125. https://doi.org/10.17941/agd.1150314

test-5