Lokal İleri Rektum Kanseri Hastalarında Neoadjuvan Tedavi Öncesi Serum Karsinoembriyonik Antijen Düzeylerinin Neoadjuvan Tedaviye Yanıtı Öngördürücülüğü

Yıl 2015, Cilt: 29 Sayı: 1, 1 - 8, 24.03.2016

Tolga Önder , Aras Emre Canda Cihan Heybeli Hülya Ellidokuz , Cem Terzi , Mehmet Füzün

Öz

Amaç: Çalışmamızda lokal ileri evre rektum kanseri tanısı alan
hastalarda, neoadjuvan tedavi öncesi serum Karsionoembriyonik Antijen (CEA)
düzeyleri ile neoadjuvan tedaviye yanıt ölçütleri arasındaki birlikteliği
değerlendirmeyi amaçladık.

Gereçler ve Yöntem: 1993-2009 yılları arasında lokal ileri rektum kanseri tanısı
alıp takipleri Dokuz Eylül Üniversitesi Tıp Fakültesi’nde yapılan 138 hasta
incelendi. Tüm hastalara toplam 45-50 Gy dozunda (20-25 günde) preoperatif
radyoterapi uygulandı ve eş zamanlı 5-Fluorouracil (225mg/m2/gün, haftanın 5
günü) kemoterapisi verildi. Neoadjuvan tedavi sonrası 6-8 hafta içerisinde
hastalar total mezorektal eksizyon tekniği ile opere edildi. Neoadjuvan tedavi
öncesi hastalardan çalışılan serum CEA düzeyleri, neoadjuvan tedaviye yanıt
ölçütleri ile birlikte değerlendirildi.

Bulgular: Ortalama izlem süresi 42 ay olan hastaların ortalama yaşının
58 ± 13 ve 89 (%64,5)’unun erkek olduğu belirlendi. Preoperatif evrelerine
bakıldığında, 24’ü evre II (%17,4), 114’ü evre III (%82,6) olarak bulundu. 83
(%60,1) hastaya sfinkter Koruyucu Cerrahi (SKC) yapılırken diğer hastalara Abdominoperineal
Rezeksiyon (APR) uygulandı. Postoperatif 8 (%5,8) hastada patolojik tam yanıt
saptandı. Hastaların 86’sında (%62,3) neoadjuvan tedavi sonrası evre gerilemesi
saptandı. Ortalama CEA değeri 11,1 ± 23,6 ng/ml (dağılım; 0,32-202ng/ml) idi.
74 hastanın (%53,6) CEA düzeyi ≤5 ng/ml olarak kaydedildi. İzlemde 19 hastada
lokorejyonel nüks saptandı. Neoadjuvan tedavi öncesi CEA düzeyi 3,5 ng/mL
altında olan hastalarda lokorejyonel nüks sıklığı istatistiksel olarak anlamlı
şekilde daha düşüktü. Neoadjuvan tedaviye yanıtlılarda genel sağ kalım 127±13
ay (p<0,001), hastalıksız sağ
kalım 99,9 ± 11,2 ay (p<0,001)
olarak hesaplandı.

Tartışma
ve sonuç: Tedavi öncesi ≤3,5 ng/ml CEA değeri neoadjuvan
tedaviye yanıt konusunda fikir verebilir. 

Anahtar Kelimeler

karsinoembriyonik antijen, kolorektal kanser

Kaynakça

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