MODİFİYE SİSTEMİK İNFLAMASYON SKORU İLE GASTROİNTESTİNAL STROMAL TÜMÖRLERİN PROGNOSTİK GÖSTERGELERİ ARASINDAKİ İLİŞKİ

Öz

Amaç Gastrointestinal stromal tümörler, gastrointestinal sistem boyunca yerleşebilen mezenkimal kökenli tümörlerdir. Bu çalışmada Modifiye sistemik inflamasyon skorunun (mSIS) bu tümörlerin prognozunu öngörmedeki rolü araştırıldı. Gereç ve Yöntem 1 Haziran 2019 ile 1 Aralık 2022 tarihleri arasında Ankara Şehir Hastanesi'nde ameliyat edilen Gastrointestinal Stromal Tümör (GIST) tanısı alan 115 hasta incelendi. Tümörün lokalizasyonu, boyutu, rüptür-kanama- nekroz varlığı, ki-67 düzeyi, mitotik indeks ve ameliyat öncesi albümin, lenfosit ve monosit düzeyleri değerlendirildi. mSIS skoru 0, 1 ve 2 olarak gruplandırıldı. mSIS ile Ki-67 indeksi, rüptür, nekroz ve kanama varlığı ile ilişkisi araştırıldı. Bulgular 115 hastanın 68'i (% 59) erkek, 47'si (% 41) kadın olup yaş ortalaması 62,5 (± 12,67) idi. Tümör lokasyonları: mide (% 64,3), ince bağırsak (% 26), kolon (% 5,2), yemek borusu (% 1,8), pankreas (% 1,8) ve yumurtalık (% 0,9). 25'inde (% 30,7) nekroz, 67'sinde (% 58,7) kanama, 19'unda (% 16,8) rüptür vardı ve ortalama Ki-67 düzeyi 9,09 (± 10,64) idi. Hastaların 63'ünde (% 54,8) mSIS 0, 29'unda (% 25,2) mSIS 1 ve 23'ünde (% 20) mSIS 2 vardı. İstatistiksel analizlerde, mSIS ile nekroz mevcudiyeti arasında anlamlı bir korelasyon bulundu. Sonuç mSIS skoru vücuttaki inflamasyonu gösteren değerli bir skordur ve birçok malignitenin prognozu ile ilişkili olduğu gösterilmiştir. Çalışmamızda tümörde nekroz varlığı mSIS skoru ile ilişkili bulunmuştur. Bu sonuç tek başına prognozu tahmin etmek için yeterli olmasa da yeni çalışmalara kapı açabilecek bir konu olduğu düşünülmektedir.

Anahtar Kelimeler

• Gastrointestinal stromal tümör
• Modifiye sistemik inflamasyon skoru
• Prognoz
• Tümör nekrozu

THE RELATION BETWEEN MODIFIED SYSTEMIC INFLAMMATION SCORE AND PROGNOSTIC MARKERS OF GASTROINTESTINAL STROMAL TUMORS

Öz

Objective Gastrointestinal stromal tumours are tumours of mesenchymal origin that can be located along the gastrointestinal tract. In this study, the role of Modified systemic inflammation score in predicting the prognosis of these tumours was investigated. Material and Method 115 patients diagnosed with Gastrointestinal Stromal Tumor (GIST) who underwent surgery at Ankara City Hospital between June 1, 2019 and December 1, 2022 were examined. Tumor location, size, presence of rupture-bleeding-necrosis, Ki-67 level, mitotic index and preoperative albumin, lymphocyte and monocyte levels were evaluated. mSIS score was grouped as 0, 1 and 2. The relationship between mSIS and Ki- 67 index and the presence of rupture, necrosis and bleeding was investigated. Results Out of 115 patients, 68 (59 %) were male, 47 (41 %) were female, with an average age of 62.5 (± 12.67) years. Tumor locations: stomach (64.3 %), small intestine (26 %), colon (5.2 %), esophagus (1.8 %), pancreas (1.8 %), and ovary (0.9 %). Necrosis was in 25 (30.7 %), hemorrhage in 67 (58.7 %), rupture in 19 (16.8 %), and the mean Ki-67 level was 9.09 (± 10.64). 63 (54.8 %) patients had mSIS 0, 29 (25.2 %) had mSIS 1, and 23 (20 %) had mSIS 2. Statistical analysis found a significant correlation between mSIS and necrosis, but not with other parameters. Conclusion The mSIS score is a valuable score showing inflammation in the body and has been shown to be associated with the prognosis of many malignancies. In our study, the presence of necrosis in the tumour was found to be associated with the mSIS score. Although this result alone is not sufficient to predict the prognosis, it is thought to be an issue that may open the door to new studies.

Anahtar Kelimeler

• Gastrointestinal stromal tumour
• Modified systemic inflammation score
• Prognosis
• Tumour necrosis

Kaynakça

1. 1. Parab TM, DeRogatis MJ, Boaz AM, Grasso SA, Issack PS, Duarte DA, et al. Gastrointestinal stromal tumors: a comprehensive review. Journal of gastrointestinal oncology 2019;10(1):144.
2. 2. von Mehren M, Rubin BP, Flieder DB, Raut CP. Gastrointestinal stromal tumors. Textbook of Uncommon Cancer 2017:470-92.
3. 3. Ahmed M. Recent advances in the management of gastrointestinal stromal tumor. World journal of clinical cases 2020;8(15):3142.
4. 4. Mantese G. Gastrointestinal stromal tumor: epidemiology, diagnosis, and treatment. Current opinion in gastroenterology 2019;35(6):555-9.
5. 5. Zhang H, Liu Q. Prognostic indicators for gastrointestinal stromal tumors: a review. Translational Oncology 2020;13(10):100812.
6. 6. Yi M, Xia L, Zhou Y, Wu X, Zhuang W, Chen Y, et al. Prognostic value of tumor necrosis in gastrointestinal stromal tumor: A meta-analysis. Medicine 2019;98(17): e15338.
7. 7. Climent M, Ryan ÉJ, Stakelum Á, Khaw YL, Creavin B, Lloyd A, et al. Systemic inflammatory response predicts oncological outcomes in patients undergoing elective surgery for mismatch repair-deficient colorectal cancer. International journal of colorectal disease 2019;34:1069-78.
8. 8. Suzuki Y, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Kondo T, et al. Comparison of Preoperative Inflammationbased Prognostic Scores in Patients With Colorectal Cancer. Ann Surg. 2018;267(3):527-31.

9. 9. Demirelli B, Babacan NA, Ercelep Ö, Öztürk MA, Kaya S, Tanrıkulu E, et al. Modified Glasgow prognostic score, prognostic nutritional index and ECOG performance score predicts survival better than sarcopenia, cachexia and some inflammatory indices in metastatic gastric cancer. Nutrition and cancer 2021;73(2):230-8.
10. 10. Tuomisto AE, Mäkinen MJ, Väyrynen JP. Systemic inflammation in colorectal cancer: Underlying factors, effects, and prognostic significance. World journal of gastroenterology 2019;25(31):4383.
11. 11. Lin J-X, Lin J-P, Xie J-W, Wang J-b, Lu J, Chen Q-Y, et al. Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer. Gastric Cancer 2019;22:403-12.
12. 12. Ataş H, Korukluoğlu B, Çomçali B, Yakşi N, SAYLAM B, Tez M. Can preoperative modified systemic inflammation score (mSIS) be used to predictmalignancy in persistent nondiagnostic thyroid nodules? Turkish Journal of Medical Sciences 2021;51(2):700-5.
13. 13. Nishida T, Cho H, Hirota S, Masuzawa T, Chiguchi G, Tsujinaka T. Clinicopathological features and prognosis of primary GISTs with tumor rupture in the real world. Annals of Surgical Oncology 2018;25:1961-9.
14. 14. Liu X, Qiu H, Zhang P, Feng X, Chen T, Li Y, et al. Prognostic role of tumor necrosis in patients undergoing curative resection for gastric gastrointestinal stromal tumor: a multicenter analysis of 740 cases in China. Cancer medicine 2017;6(12):2796-803.
15. 15. Liu Q, Li Y, Dong M, Kong F, Dong Q. Gastrointestinal bleeding is an independent risk factor for poor prognosis in GIST patients. BioMed research international 2017:2017:7152406. doi: 10.1155/2017/7152406.
16. 16. Lv A, Li Z, Tian X, Guan X, Zhao M, Dong B, Hao C. SKP2 high expression, KIT exon 11 deletions, and gastrointestinal bleeding as predictors of poor prognosis in primary gastrointestinal stromal tumors. PloS one 2013;8(5):e62951. https://doi.org/10.1371/journal.pone.006295