Gross tümör volumü ve az diferansiye kümeler pT1- 2 rektum karsinomlarında kötü sağ kalım açısından yüksek riskli hastaları gösterebilir

Abstract

Amaç: Rektal karsinomlar batı dünyasında en sık görülen kanserlerden biridir. Hastaların sağkalımı temel olarak tümör-nod-metastaz (TNM) evresi ile ilişkilidir, ancak aynı tümör evresindeki hastalar sıklıkla belirgin farklı sağkalımlara sahiptir. Biz rektal karsinomlarda gross tümör volumü (GTV) ve az diferansiye kümeler (ADK)’in hayatta kalmaya etkilerini analiz ettik.
Gereç ve Yöntem: Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi’nde 1999-2014 yılları arasında ameliyat edilen altmış beş pT1-2 rektal karsinom retrospektif olarak çalışmaya dahil edildi. GTV ve ADK kümeler makroskopi ve hematoksilen ve eozin boyalı kesitler kullanılarak skorlandı.
Bulgular: Bu parametreler büyük tümör boyutu ([GTV]: p=0,020), invasive patern (GTV: p=0,004; [ADK]: p=0,020), anjiolenfatik invazyon (GTV: p=0,001; ADK: p=0,009), tümör nekrozu (GTV: p=0,002; ADK: p=0,038) ve yüksek grade (ADK: p=0,001) ile anlamlı olarak ilişkili idi. Tek değişkenli analizde, bu iki parametreye sahip hastalar nükssüz sağkalım (NSS) ve genel sağkalım (GS) açısından 5 yıllık kötü sağkalıma sahipti ([GTV: NSS=%78,5, p=0.001; GS: %81,0, p=0,005], [PDC: NSS= %80,0, p=0,013; GS=83,1%, p=0,039]). Çok değişkenli analiz, bu iki parametrenin NSS (GTV: Hazard ratio [HR]= 42 [1,06-2,85], p=0,006; PDC: HR=1,39 [1,06-3,28], p=0,028) ve GS (GTV: HR=1,35 [1,09-3,37], p=0,011) için bağımsız kötü hayatta kalma parametreleri olduğunu doğruladı. Ayrıca, GTV’nin ADK’dan daha yararlı olduğu tesbit edildi.
Sonuçlar: Çalışmamıza göre GTV ve ADK, rektal karsinomlu hastalarda prognozda önemli bir rol oynamaktadır ve mevcut risk sınıflamasına bu belirteçleri eklemek daha iyi hasta seçimine katkıda bulunabilir.

Keywords

• Gross tümör volumü,azdiferansiye kümeler,rektum karsinomları,prognostik belirteçler,pT1-2.

Gross tumour volume and poorly differentiated clusters can indicate the high-risk patients for poor survival in pT1- 2 rectum carcinomas

Abstract

Aim: Colorectal carcinomas are one of the most common carcinomas in the Western world. Survival is mainly associated with the tumour-node-metastasis (TNM) stage but patients with the same tumour stage usually show marked distinct survival. We analyzed the survival effect of gross tumour volume and poorly differentiated clusters in pT1-2 rectal carcinomas.
Material and Method: Sixty-five pT1-2 rectal carcinomas that were curatively resected between 1999 and 2014 were included in this retrospective study at Kırıkkale University Medical Faculty Hospital. Gross tumour volume and poorly differentiated clusters were scored using a macroscopic specimen and hematoxylin and eosin-stained sections.
Results: These parameters were significantly associated with large tumour size (gross tumour volume [GTV]: p=0.020), invasive pattern (GTV: p=0.004; poorly differentiated clusters [PDC]: p=0.020), angiolymphatic invasion (GTV: p=0.001; PDC: p=0.009), tumour necrosis (GTV: p=0.002; PDC: p=0.038), and high grade (PDC: p=0.001). In univariate analysis, patients with these parameters had worse 5-year survival for both relapse-free survival (RFS) and overall survival (OS) ([GTV: RFS= 78.5%, p=0.001; OS: 81.0%, p=0.005], [PDC: RFS= 80.0%, p=0.013; OS: 83.1%, p=0.039]). Multivariate analysis confirmed that these parameters are independent predictors of poor survival for RFS (GTV: Hazard ratio [HR]=1.42 [1.06-2.85], p=0.006; PDC: HR=1.39 [1.06-3.28], p=0.028) and OS (GTV: HR=1.35 [1.09-3.37], p=0.011). Also, GTV was found to be more useful than PDC.
Conclusions: According to our study, GTV and PDC play an important role in the prognosis of rectal carcinomas and the addition of these markers to the current risk classification may contribute to better patient selection.

Keywords

• Gross tumour volume,poorly differentiated clusters,rectum carcinomas,prognostic markers,pT1-2.

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