A new approach to lymphedema following breast cancer treatment with lymphatic endothelial cell markers

Abstract

Amaç: Lenfödem (LE), aksiller lenf nodu diseksiyonu ve radyoterapi ile tedavi edilen meme kanserli olgularda yaygın gelişen iyatrojenik bir komplikasyondur. Bu çalışmada lenfödemli hastalarda meme kanseri tedavisi sonrası, lenfatik sistem endotelinden salınan, homeobox transkripsiyon faktörü (Prox-1), lenfatik damar endotel reseptörü-1 (LVYE-1) ve podoplanin (PDPN) belirteçlerinin serum düzeylerini araştırmayı amaçladık. Metod: Çalışmanın LE grubunu meme kanseri tedavisi sonrası üst ekstremitede LE gelişen toplam 44 kadın hasta, kontrol grubunu ise demografik açıdan LE grubu ile benzer özellikler gösteren 44 sağlıklı kadın oluşturdu. Hastaların kol çevreleri ölçüldü ve her iki kol çevresi toplamları arasındaki fark (DSOAC) 2 cm veya ≥ %10 ise LE olarak kabul edildi. Serum Prox-1, LVYE-1 ve PDPN konsantrasyonları ticari ELISA (Enzyme-linked immunosorbent assay) ile ölçüldü. Bulgular: LE grubunda Prox-1, LVYE-1 ve PDPN seviyeleri kontrol grubuna göre anlamlı olarak düşük bulundu (sırasıyla; p < 0.01, p = 0.02, p = 0.04). Prox-1 seviyeleri Evre 1 LE'li hastalarda Evre 2 LE’li hastalara göre anlamlı yüksekti (p<0.001). Prox-1 seviyeleri ile DSOAC ve çıkarılan aksiller lenf nodu sayısı arasında zayıf ve negatif korelasyon gözlemlenirken (r = −0.417 ve −0.426, sırasıyla; p < 0.01), DSOAC ve çıkarılan aksiller lenf nodu sayısı arasında orta derecede pozitif korelasyon saptandı (r = 0.533, p < 0.001). Sonuç: Çalışmamız sonucunda meme kanseri tedavisine sekonder gelişen lenfödemde Prox-1, LVYE-1 ve PDPN seviyeleri düşük bulunmuştur. Lenfatik endotel hücre belirteçlerinin lenfödem ile ilişkisinin inceleneceği ileri araştırmalar, LE tanı, prognoz ve tedavisinde yeni perspektiflerin geliştirilmesine yardımcı olabilir. Anahtar Kelimeler:Lenfatik endotel hücre belirteçleri, seconder lenfödem, lenfanjiogenez

Keywords

• Lymphatic endothelial cell markers
• secondary lymphedema
• lymphangiogenesis

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