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

Yıl 2020, Cilt: 3 Sayı: 3, 196 - 202, 18.06.2020
https://doi.org/10.32322/jhsm.634367

Öz

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.

Kaynakça

  • 1. Yeop Oh S, Bae Kim Y, Wook Suh K. Oncologic outcome of ypT1-2N0 rectal cancer after neoadjuvant chemoradiotherapy compared With pT1-2N0 rectal cancer. Am J Clin Oncol 2017 Oct; 40: 512-6.
  • 2. Wan JF, Zhu J, Li GC, et al. YpT1-2N0 rectal cancer after neoadjuvant chemoradiation has lower survival compared with pT1-2N0 rectal cancer. Oncotarget 2015 Dec 1; 6: 41056-62.
  • 3. Borstlap WA, Coeymans TJ, Tanis PJ, et al. Meta-analysis of oncological 0utcomes after local excision of pT1-2 rectal cancer requiring adjuvant (chemo)radiotherapy or completion surgery. Br J Surg 2016 Aug; 103: 1105-16.
  • 4. Doweck I, Denys D, Robbins KT. Tumor volume predicts outcome for advanced head and neck cancer treated with targeted chemoradiotherapy. Laryngoscope 2002; 112: 1742-9.
  • 5. Lv Y, Wang X, Liang L, et al. SUVmax and metabolic tumor volume: surrogate ımage biomarkers of KRAS mutation status in colorectal cancer. Onco Targets Ther 2019; 12: 2115-21.
  • 6. Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for node-positive (Stage III) colon cancer: an analysis of 50,042 patients. Ann Surg 2002; 236: 416–21.
  • 7. Deans GT, Heatley M, Anderson N, et al. Jass Classification Revisited. J Am Coll Surg 1994; 179: 11–7.
  • 8. Ueno H, Kajiwara Y, Shimazaki H, et al. New criteria for histologic grading of colorectal cancer Am J Surg Pathol 2012; 36: 193-201.
  • 9. Ueno H, Hase K, Hashiguchi Y, et al. Site-specific tumor grading system in colorectal cancer: multicenter pathologic review of the value of quantifying poorly differentiated clusters. Am J Surg Pathol 2014; 38: 197-204.
  • 10. Sobin LH, Compton CC. TNM Seventh Edition: What’s New, What’s Changed: Communication From the International Union Against Cancer and the American Joint Committee on Cancer. Cancer 2010; 116: 5336–9.
  • 11. Goldstein NS, Soman A, Sacksner J. Disparate surgical margin lengths of colorectal resection specimens between ın vivo and ın vitro measurements. The effects of surgical resection and formalin fixation on organ shrinkage. Am J Clin Pathol 1999 Mar; 111: 349-51.
  • 12. Park IJ, You YN, Skibber JM, et al. Comparative analysis of lymph node metastases in patients with ypT0-2 rectal cancers after neoadjuvant chemoradiotherapy. Dis Colon Rectum 2013; 56: 135–41.
  • 13. Govindarajan A, Reidy D, Weiser MR, et al. Recurrence rates and prognostic factors in ypN0 rectal cancer after neoadjuvant chemoradiation and total mesorectal excision. Ann Surg Oncol 2011; 18: 3666–72.
  • 14. Burbach JP, Kleijnen JP, Reerink O, et al. Inter-observer agreement of MRI-based tumor delineation for preoperative radiotherapy boost in locally advanced rectal cancer. Radiother Oncol 2016; 118: 399-407.
  • 15. Burbach JP, den Harder AM, Intven M, et al. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol 2014; 113: 1-9.
  • 16. Archer CR, Yeager VL, Herbold DR. Improved diagnostic accuracy in laryngeal cancer using new classification based on computed tomography. Cancer 1984; 53: 44–57.
  • 17. Isaacs JH, Mancuso AA, Mendenhall WM. CT scanning as an aid to selection of therapy in t2‐t4 laryngeal cancers. Head Neck Surg 1988; 99: 455–64.
  • 18. Woff E, Kehagias P, Vandeputte C, et al. Combining 18F-FDG PET/CT-based metabolically active tumor volume and circulating cell-free dna significantly ımproves outcome prediction in chemorefractory metastatic colorectal cancer. J Nucl Med 2019; 60: 1366-72.
  • 19. Woff E, Hendlisz A, Ameye L, et al. Validation of metabolically active tumor volume and total lesion glycolysis as 18F-FDG PET/CT–derived prognostic biomarkers in chemorefractory metastatic colorectal cancer. J Nucl Med 2018; 60: 178-84.
  • 20. Bosman FT, World Health Organization, and International Agency for Research on Cancer. WHO Classification of Tumours of the Digestive System. Lyon: International Agency for Research on Cancer, 5th edition, 2019.
  • 21. Barresi V, Bonetti RL, Leni A, et al. Histologic prognostic markers in stage IIA colorectal cancer: a comparative study. Scand J Gastroenterol 2016; 51: 314-20.
  • 22. Barresi V, Branca G, Leni A, et al. Poorly differentiated clusters (PDCs) as a novel histological predictor of nodal metastases in pT1 colorectal cancer. Virchows Arch 2014; 464: 655-62.

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

Yıl 2020, Cilt: 3 Sayı: 3, 196 - 202, 18.06.2020
https://doi.org/10.32322/jhsm.634367

Öz

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.

Kaynakça

  • 1. Yeop Oh S, Bae Kim Y, Wook Suh K. Oncologic outcome of ypT1-2N0 rectal cancer after neoadjuvant chemoradiotherapy compared With pT1-2N0 rectal cancer. Am J Clin Oncol 2017 Oct; 40: 512-6.
  • 2. Wan JF, Zhu J, Li GC, et al. YpT1-2N0 rectal cancer after neoadjuvant chemoradiation has lower survival compared with pT1-2N0 rectal cancer. Oncotarget 2015 Dec 1; 6: 41056-62.
  • 3. Borstlap WA, Coeymans TJ, Tanis PJ, et al. Meta-analysis of oncological 0utcomes after local excision of pT1-2 rectal cancer requiring adjuvant (chemo)radiotherapy or completion surgery. Br J Surg 2016 Aug; 103: 1105-16.
  • 4. Doweck I, Denys D, Robbins KT. Tumor volume predicts outcome for advanced head and neck cancer treated with targeted chemoradiotherapy. Laryngoscope 2002; 112: 1742-9.
  • 5. Lv Y, Wang X, Liang L, et al. SUVmax and metabolic tumor volume: surrogate ımage biomarkers of KRAS mutation status in colorectal cancer. Onco Targets Ther 2019; 12: 2115-21.
  • 6. Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for node-positive (Stage III) colon cancer: an analysis of 50,042 patients. Ann Surg 2002; 236: 416–21.
  • 7. Deans GT, Heatley M, Anderson N, et al. Jass Classification Revisited. J Am Coll Surg 1994; 179: 11–7.
  • 8. Ueno H, Kajiwara Y, Shimazaki H, et al. New criteria for histologic grading of colorectal cancer Am J Surg Pathol 2012; 36: 193-201.
  • 9. Ueno H, Hase K, Hashiguchi Y, et al. Site-specific tumor grading system in colorectal cancer: multicenter pathologic review of the value of quantifying poorly differentiated clusters. Am J Surg Pathol 2014; 38: 197-204.
  • 10. Sobin LH, Compton CC. TNM Seventh Edition: What’s New, What’s Changed: Communication From the International Union Against Cancer and the American Joint Committee on Cancer. Cancer 2010; 116: 5336–9.
  • 11. Goldstein NS, Soman A, Sacksner J. Disparate surgical margin lengths of colorectal resection specimens between ın vivo and ın vitro measurements. The effects of surgical resection and formalin fixation on organ shrinkage. Am J Clin Pathol 1999 Mar; 111: 349-51.
  • 12. Park IJ, You YN, Skibber JM, et al. Comparative analysis of lymph node metastases in patients with ypT0-2 rectal cancers after neoadjuvant chemoradiotherapy. Dis Colon Rectum 2013; 56: 135–41.
  • 13. Govindarajan A, Reidy D, Weiser MR, et al. Recurrence rates and prognostic factors in ypN0 rectal cancer after neoadjuvant chemoradiation and total mesorectal excision. Ann Surg Oncol 2011; 18: 3666–72.
  • 14. Burbach JP, Kleijnen JP, Reerink O, et al. Inter-observer agreement of MRI-based tumor delineation for preoperative radiotherapy boost in locally advanced rectal cancer. Radiother Oncol 2016; 118: 399-407.
  • 15. Burbach JP, den Harder AM, Intven M, et al. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol 2014; 113: 1-9.
  • 16. Archer CR, Yeager VL, Herbold DR. Improved diagnostic accuracy in laryngeal cancer using new classification based on computed tomography. Cancer 1984; 53: 44–57.
  • 17. Isaacs JH, Mancuso AA, Mendenhall WM. CT scanning as an aid to selection of therapy in t2‐t4 laryngeal cancers. Head Neck Surg 1988; 99: 455–64.
  • 18. Woff E, Kehagias P, Vandeputte C, et al. Combining 18F-FDG PET/CT-based metabolically active tumor volume and circulating cell-free dna significantly ımproves outcome prediction in chemorefractory metastatic colorectal cancer. J Nucl Med 2019; 60: 1366-72.
  • 19. Woff E, Hendlisz A, Ameye L, et al. Validation of metabolically active tumor volume and total lesion glycolysis as 18F-FDG PET/CT–derived prognostic biomarkers in chemorefractory metastatic colorectal cancer. J Nucl Med 2018; 60: 178-84.
  • 20. Bosman FT, World Health Organization, and International Agency for Research on Cancer. WHO Classification of Tumours of the Digestive System. Lyon: International Agency for Research on Cancer, 5th edition, 2019.
  • 21. Barresi V, Bonetti RL, Leni A, et al. Histologic prognostic markers in stage IIA colorectal cancer: a comparative study. Scand J Gastroenterol 2016; 51: 314-20.
  • 22. Barresi V, Branca G, Leni A, et al. Poorly differentiated clusters (PDCs) as a novel histological predictor of nodal metastases in pT1 colorectal cancer. Virchows Arch 2014; 464: 655-62.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Mehmet Zengin 0000-0003-1937-2771

Pınar Atasoy 0000-0002-5603-8265

Yayımlanma Tarihi 18 Haziran 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 3 Sayı: 3

Kaynak Göster

AMA Zengin M, Atasoy P. Gross tumour volume and poorly differentiated clusters can indicate the high-risk patients for poor survival in pT1- 2 rectum carcinomas. J Health Sci Med /JHSM /jhsm. Haziran 2020;3(3):196-202. doi:10.32322/jhsm.634367

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Not:
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