COVID-19 pandemisinin mide kanseri evresi ve beslenme durumu üzerindeki etkisi

Abstract

Giriş: COVID-19 pandemisi, dünya genelinde özellikle gastrointestinal (GI) endoskopi hizmetlerini ciddi şekilde kesintiye uğratmış ve gastrik kanserde gecikmiş tanılar ile evre kayması (stage migration) konusunda endişelere yol açmıştır. Gastrik karsinogenezde önemli rol oynayan Helicobacter pylori (H. pylori) aynı zamanda SARS-CoV-2’ye karşı mukozal duyarlılığı da etkileyebilir. Ancak bu aksaklıkların gastrik kanser profili üzerindeki etkilerine dair gerçek yaşam verileri sınırlıdır. Amaç: Pandemi ve post-pandemi dönemlerinde üst GI endoskopi yapılan hastaların klinik, endoskopik ve patolojik özelliklerini karşılaştırmak ve gastrik kanserli hastalarda beslenme durumu ile tümör yükü arasındaki ilişkiyi değerlendirmek. Yöntemler: Bu retrospektif kohort çalışmaya, dispeptik ya da alarm semptomları nedeniyle üçüncü basamak bir merkezde tanısal üst GI endoskopi yapılan 478 hasta dahil edildi. Hastalar pandemi (Haziran 2021–Haziran 2022; n = 216) ve post-pandemi (Mayıs–Ekim 2023; n = 262) olmak üzere iki gruba ayrıldı. Demografik veriler, semptomlar, endoskopik ve histopatolojik bulgular ile beden kitle indeksi (BKİ) analiz edildi. İstatistiksel analizlerde t-testi, Ki-kare testi, lojistik regresyon ve Spearman korelasyon yöntemleri kullanıldı. Bulgular: Pandemi döneminde değerlendirilen hastalar daha sık alarm semptomları bildirdi ve anlamlı derecede daha düşük kilo ve BKİ’ye sahipti. H. pylori pozitifliği (%41,7 vs. %28,2; p = 0,03), peptik ülser (%16,7 vs. %8,4; p = 0,04) ve gastrik kanser (%7,4 vs. %2,3; p = 0,02) pandemi grubunda daha yüksekti. Gastrik kanser tanısı alan 22 hastanın pandemi döneminde tanı alanlarında daha ileri evre hastalık (T3–T4: %75,0 vs. %33,3; p = 0,02), daha sık nodal tutulum (%62,5 vs. %16,7; p = 0,01) ve daha düşük BKİ saptandı. Çok değişkenli analizde pandemi döneminde endoskopi yapılması, ileri evre gastrik kanser için bağımsız bir risk faktörü olarak bulundu (OR = 3,41; %95 GA: 1,31–8,88; p = 0,008). BKİ ile tümör derinliği (ρ = –0,73) ve nodal tutulum (ρ = –0,87) arasında güçlü ters korelasyonlar gösterildi. Sonuç: COVID-19 pandemisi, tanı gecikmeleri ve ileri evre gastrik kanser olgularının artışı ile ilişkili bulunmuştur. BKİ, tümör agresifliğiyle güçlü ters ilişki göstermiş olup, hastalık yükünü öngörmede pratik bir gösterge olma potansiyeline sahiptir. Ancak çalışmamızdaki hasta sayısının sınırlı olması, bulguların genellenebilirliğini azaltmaktadır. Bu nedenle çok merkezli, daha geniş hasta gruplarını içeren ileri çalışmalara ihtiyaç vardır. Bulgular, salgın dönemlerinde endoskopik tanı hizmetlerinin sürekliliğinin önemini ve beslenme göstergelerinin prognostik değerini vurgulamaktadır

Keywords

• Beden Kitle İndeksi;
• COVID-19;
• Endoskopi;
• Gastrik Kanser;
• Helicobacter pylori;

The Impact of the COVID-19 pandemic on gastric cancer stage and nutritional status

Abstract

Aims: The COVID-19 pandemic disrupted diagnostic services worldwide, particularly gastrointestinal (GI) endoscopy, raising concerns about delayed diagnoses and stage migration in gastric cancer. Helicobacter pylori (H. pylori), a key factor in gastric carcinogenesis, may also influence mucosal susceptibility to SARS-CoV-2. However, data on how these disruptions affected gastric cancer profiles remain limited. To compare clinical, endoscopic, and pathological features of patients undergoing upper GI endoscopy during and after the COVID-19 pandemic, and to evaluate the association between nutritional status and tumor burden in gastric cancer patients. Methods: This retrospective cohort study included 478 patients who underwent diagnostic upper GI endoscopy due to dyspeptic or alarm symptoms at a tertiary care center in Turkiye. Patients were divided into two groups: pandemic (June 2021 to June 2022; n=216) and post-pandemic (May to October 2023; n=262). Demographics, symptoms, endoscopic and histopathological findings, and body-mass index (BMI) were analyzed. Statistical methods included t-tests, Chi-square tests, logistic regression, and Spearman correlation. Results: Patients evaluated during the pandemic more frequently reported alarm symptoms and had significantly lower weight and BMI. H. pylori positivity (41.7% vs. 28.2%; p=0.03), peptic ulcer (16.7% vs. 8.4%; p=0.04), and gastric cancer (7.4% vs. 2.3%; p=0.02) were all more prevalent in the pandemic group. Among 22 patients with gastric cancer, those diagnosed during the pandemic exhibited more advanced disease (T3-T4: 75.0% vs. 33.3%; p=0.02), more frequent nodal involvement (62.5% vs. 16.7%; p=0.01), and BMI. Pandemic-period endoscopy remained an independent predictor of advanced-stage gastric cancer in multivariable analysis (OR=3.41; 95% CI: 1.31-8.88; p=0.008). Strong inverse correlations were found between BMI and tumor depth (p=-0.73), and between BMI and nodal involvement (p=-0.87). Conclusion: The COVID-19 pandemic was associated with diagnostic delays and increased frequency of advanced-stage gastric cancer. BMI showed a strong inverse relationship with tumor aggressiveness and has potential to serve as a practical indicator of disease burden. These findings underscore the importance of preserving access to endoscopic diagnostics and highlight the prognostic value of nutritional parameters during public health emergencies.

Keywords

• BMI
• COVID-19
• endoscopy
• gastric cancer
• Helicobacter pylori
• nutritional status

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