Servikal Kanserde Prognozu Etkileyen Faktörler ve Neoadjuvan Tedavinin Prognoza Etkisi

Öz

Amaç: FIGO 2009 Evre 1B2 ve üzeri lokal ileri evre serviks kanserli hastalarda tedavi seçeneği olarak Radikal Histerektomi ile neoadjuvan kemoterapi sonrası Radikal Histerektominin genel ve hastalıksız sağkalıma etkisi araştırıldı. Gereç ve Yöntem: Çalışma Şubat 2007 – Ocak 2015 tarihleri arasında Başkent Üniversitesi Jinekolojik Onkoloji Bölümünde tedavi edilen 119 FİGO 2009 evre 1B2 ve üzeri lokal ileri serviks kanserli hastaları içermekte olup retrospektif olarak düzenlendi. Hastalar jinekolojik muayene ile klinik olarak evrelendirilip, görüntüleme tetkikleri ile değerlendirildikten sonra, tedavi planlarına göre 2 gruba ayrıldı. Primer olarak cerrahi yapılacak hastalara (grup1) Radikal histerektomi ve lenf nodu diseksiyonu yapıldı. Neoadjuvan kemoterapi uygulanan hastalarda ise (grup 2) 3 kür kemoterapi verildikten sonra radikal histerektomi ve lenf nodu diseksiyonu uygulandı. Çalışmada bu iki grup arasında genel ve hastalıksız sağkalım süreleri araştırıldı. Ayrıca genel ve hastalıksız sağkalımı etkileyen faktörler araştırıldı. Bulgular: Hastaların ortalama yaşı 56 (32-85) idi, ortalama takip süresi ise 35(1-100) aydı. 119 hastanın 36’sına neoadjuvan kemoterapi uygulanırken, 83 hasta primer cerrahi grubundaydı. 5 yıllık genel sağkalım neoadjuvan kemoterapi grubunda %51,7 (56,3 ay), primer cerrahi uygulanan grupta ise %73,5 (79,2 ay) olarak bulundu (p=0,03). Hastalıksız sağkalım ise neoadjuvan alan grupta %48,2 (49,2 ay) bulunurken bu oran primer cerrahi grubu için %61,4 (67,7 ay) olarak hesaplandı (p=0,17). Primer cerrahi yapılan grubunun genel sağ kalım hızı, neoadjuvan kemoterapi sonrası cerrahi uygulanan hastalardan anlamlı olarak yüksekti (p=0.036). Sonuç: Çalışmamızda servikal kanserli hastalarda uygulanan 2 farklı tedavi şekli karşılaştırılmış olup, primer olarak radikal histerektomi ve lenf nodu diseksiyonu yapılan hastalarda genel sağkalım hızının, neoadjuvan kemoterapi sonrası radikal histerektomi ile lenf nodu diseksiyonu uygulanan hastalardan istatiksel olarak daha iyi olduğu saptanmıştır. Neoadjuvan kemoterapi tedavisi lokal ileri evre serviks kanserli hastalarda standart bir tedavi şekli olmayıp çalışmamızda da genel ve hastalıksız sağkalıma etkisi olmadığı saptanmıştır. Neoadjuvan kemoterapinin lenf nodu tutulumuna ve tümör çapına etkisi olduğu bulunmuştur.

Anahtar Kelimeler

• neoadjuvan kemoterapi
• servikal kanser
• evre 1B2

The Factors Affecting on Prognosis in Cervical Cancer and the Effect of Neoadjuvant Chemotherapy

Öz

ABSTRACT Aim: The effects of Radical Hysterectomy and Radical Hysterectomy after neoadjuvant chemotheraphy on overall and disease-free survival were investigated in FIGO 2009 Stage 1B2 and higher locally advanced cervical cancer. Materials and Methods: This retrospective study included 119 FIGO 2009 stage 1B2 and locally advanced cervical cancer patients treated in Baskent University Department of Gynecological Oncology between February 2007 and January 2015. The patients were divided into 2 groups according to their treatment plans after they were clinically stratified by gynecological examination and evaluated with imaging techniques. Radical hysterectomy and lymph node dissection were performed in group 1, who would undergo primary surgery. Radical hysterectomy and lymph node dissection were performed after 3 cycles of neoadjuvant chemotherapy in group 2. In the study, overall and disease-free survival between these two groups were investigated. In addition, factors affecting overall and disease-free survival were investigated. Results: The mean age of the patients was 56 (32-85), and the mean follow-up period was 35 (1-100) months. While neoadjuvant chemotherapy was applied to 36 of 119, 83 patients were primary underwent surgery. The 5-year overall survival was 51.7% (56.3 months) in the neoadjuvant group and 73.5% (79.2 months) in the primary surgery group (p=0.03). Disease-free survival was 48.2% (49.2 months) in the neoadjuvant group, while this rate was 61.4% (67.7 months) in the primary surgery group (p=0.17). The overall survival rate of the primary surgery group was significantly higher than that of the patients who underwent surgery after neoadjuvant chemotherapy (p=0.036). Conclusion: In our study, 2 different treatment modalities applied in patients with cervical cancer were compared, and it was determined that the overall survival rate in patients who had primarily radical hysterectomy and lymph node dissection was statistically better than those who underwent radical hysterectomy and lymph node dissection after neoadjuvant chemotherapy. Neoadjuvant chemotherapy treatment is not a standard treatment in patients with locally advanced cervical cancer, and it was found that it had no effect on overall and disease-free survival in our study. Neoadjuvant chemotherapy was found to have an effect on lymph node involvement and tumor diameter.

Anahtar Kelimeler

• cervical cancer
• stage 1B2 ,
• neoadjuvant chemotherapy

Kaynakça

1. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjo- mataram I, Jemal A et al. Global Cancer Statistics 2020: GLO- BOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209-49. 2. Shahmoradi Z, Damgacioglu H, Clarke MA, Wentzen- sen N, Montealegre J, Sonawane K et al. Cervical Cancer Inci- dence Among US Women, 2001-2019. JAMA 2022;328:2267- 9. 3. . In: https://seercancergov/statfacts/html/cervixhtml (Accessed on December 14, 2022).