Neoadjuvan kemoterapi alan lokal ileri evre mide adenokanserli hastalarda immün-inflamasyon ve tümör belirteçlerinin prognostik özellikleri

Öz

Amaç: Bu çalışmada, lokal ileri evre mide adenokarsinomlu hastalarda, neoadjuvan kemoterapi tedavisi öncesinde nötrofil, lenfosit, monosit, trombosit, nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), prognostik nutrisyonel indeks (PNİ) ve klinikopatolojik faktörlerin sağkalım üzerindeki etkisini incelemeyi amaçladık. Gereç ve Yöntemler: Bu çalışmaya tek merkezden 47 hasta dahil edildi. Hasta dosyaları retrospektif olarak incelendi. Hastaların demografik ve klinik özelliklerine ek olarak, tedavi öncesi hemoglobin, nötrofil, lenfosit, monosit, trombosit, albümin, NLR, PLR, PNİ, tümör markerleri (CEA, CA19-9) değerleri ile operasyon sonrası patolojik özelliklerinin sağkalım üzerindeki etkisi incelendi. Hastaların hastalıksız sağkalım (DFS) ve genel sağkalım (OS) değerleri Kaplan-Meier analizi ile hesaplandı. Hem DFS hem de OS'yi etkileyen faktörler, univariate ve multivariate olarak Cox regresyon analizi ile değerlendirildi. Bulgular: Median OS 27 ay ve median DFS 17 ay olarak bulundu. DFS açısından yapılan univariate analizde, tanıda monosit değerindeki artış (p: 0.009, HR: 7,0 [1,6–30]) ve D1 lenf nodu diseksiyonunun kötü prognostik değere sahip olduğu bulundu (p: 0.034, HR: 5,1 [1,1–23,3]). DFS açısından yapılan multivariate analizde, CEA değerindeki artış (p: 0.03, HR: 1,02 [1–1,03]) ve monosit değerindeki artış kötü prognoz ile ilişkili olduğu saptandı (p: 0.05, HR: 10,4 [2,03–53,5]). OS açısından yapılan multivariate analizde ise sadece tanıda CEA değerinin yükselmesi kötü prognozla ilişkili olduğu saptandı (p: 0.02, HR: 1,01 [1,00–1,02]). Sonuç: Tanı sırasında monosit değerindeki artış lokal ileri evre mide kanserinde hastalıksız sağkalımda kötüleşme ile ilgili saptandı. Yine, tanıda CEA değerindeki artış kötü sağkalımla ilişkili olduğu belirlendi. Monosit ve CEA gibi kolay ulaşılabilir ve ucuz parametrelerle, erken evre mide kanserinde hastalığın gidişatı gösterilebilir.

Anahtar Kelimeler

• mide kanseri
• monosit
• sağkalım analizi
• neoadjuvan kemoterapi
• inflamasyon

Prognostic significance of immune-inflammatory markers and tumor markers in locally advanced gastric adenocarcinoma patients receiving neoadjuvant chemotherapy

Öz

Aim: In this study, we aimed to investigate the effect of neutrophil, lymphocyte, monocyte, platelet, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and clinical-pathological factors on survival in patients with gastric cancer treated with neoadjuvant chemotherapy. Material and Methods: Forty-seven patients from a single center were included in this study. Patient medical records were reviewed retrospectively. In addition to demographic and clinical characteristics, the effects of pre-treatment levels of hemoglobin, neutrophils, lymphocytes, monocytes, platelets, albumin, NLR, PLR, PNI, and tumor markers (CEA, CA19-9), along with postoperative pathological features, on survival were evaluated. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Factors affecting both DFS and OS were analyzed using univariate and multivariate Cox regression analyses. Results: The median OS was 27 months, and the median DFS was 17 months. In the univariate analysis for DFS, increasing monocyte count at diagnosis (p = 0.009, HR: 7.0 [1.6–30]) and D1 lymph node dissection (p = 0.034, HR: 5.1 [1.1–23.3]) were found to be associated with poor prognosis. In the multivariate analysis for DFS, increasing CEA levels (p = 0.03, HR: 1.02 [1–1.03]) and increasing monocyte count at diagnosis (p = 0.05, HR: 10.4 [2.03–53.5]) were identified as poor prognostic factors. In the multivariate analysis for OS, only increasing CEA levels at diagnosis were associated with poor prognosis (p = 0.02, HR: 1.01 [1.00–1.02]). Conclusion: Increasing monocyte count at diagnosis were associated with reduced disease-free survival in locally advanced gastric cancer. Likewise, increasing CEA levels at diagnosis correlated with poorer overall survival. Readily available and cost-effective biomarkers such as monocyte count and CEA may serve as valuable indicators for predicting disease course in early-stage gastric cancer.

Anahtar Kelimeler

• gastric cancer
• monocyte
• survival analysis
• neoadjuvant chemotherapy
• inflammation

Kaynakça

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