Ezgi KARAHAN, Zeynep GÖK SARGIN, Yücel ÜSTÜNDAĞ

Kolorektal adenoma ve karsinomlu hastalarda metabolik ve inflamatuvar risk faktörlerinin değerlendirilmesi

Giriş ve Amaç: Metabolik sendrom ve ilişkili bileşenlerinin, hiperinsülinemi, insülin direnci ve kronik düşük dereceli inflamasyonla sonuçlanan oksidatif strese bağlı kolorektal neoplazmların gelişimi için risk faktörleri olduğu düşünülmektedir. Bu çalışma, kolorektal neoplazmların (kolon adenokarsinom ve kolon adenomu) metabolik sendrom bileşenleri, non-alkolik yağlı karaciğer hastalığı ve inflamatuvar belirteçlerle ilişkisini açıklamayı amaçlamaktadır. Gereç ve Yöntem: Kolon adenoma ve kolorektal adenokarsinom tanısı alan 151 hastanın verileri geriye dönük olarak incelendi. Demografik özellikler, rutin kan tetkikleri, kolonoskopik bulgular, patoloji sonuçları, kolorektal kanserin tümör-lenf nodu-metastaz evreleri ve hepatik ultrasonografi bulguları kaydedildi. İnsülin direnç testi skorları hesaplandı. Bulgular: Çalışma kohortu, kolorektal adenoma olan 71 hasta ve kolorektal kanseri olan 80 hastadan oluşuyordu. Diabetes mellitus, hipertansiyon, hipertrigliseridemi, metabolik sendrom, şiddetli karaciğer yağlanması olan hasta sayısı adenoma grubuna göre kolorektal kanser grubunda anlamlı olarak daha yüksekti. Ek olarak, nötrofil-lenfosit oranı, C-reaktif protein ve C-reaktif protein/albümin oranı, kolorektal adenoma grubuna göre, kolorektal kanser grubunda anlamlı olarak daha yüksekti. Tek değişkenli analizde diabetes mellitus, hipertansiyon, hipertrigliseridemi, metabolik sendrom, şiddetli karaciğer steatozu olan hastaların, bu risk faktörlerine sahip olmayanlara göre daha kısa sağkalım süresine sahip oldukları bulundu. Çok değişkenli analizde, ileri tümör-lenf nodu-metastaz evresi, şiddetli hepatosteatoz, hipertansiyon ve hipertrigliseridemi, kolorektal adenokanserli hastaların sağkalımı için bağımsız risk faktörleri olarak bulundu. Sonuç: Metabolik sendrom, ciddi karaciğer yağlanması ve inflamatuvar süreç, kolorektal kanser hastalarında, kolon adenomundan adenokarsinoma geçiş ve daha kısa sağkalım için risk faktörleri olabilir.

Anahtar Kelimeler:

Kolorektal adenom, kolorektal adenokanser, insulin direnci, kronik inflamasyon

Assessment of metabolic and inflammatory risk factors in patients with colorectal adenoma and carcinoma

Background and Aims: Metabolic syndrome and its related components are thought to be risk factors for developing colorectal neoplasms due to hyperinsulinemia, insulin resistance, and oxidative stress resulting in chronic low-grade inflammation. This study aims to explain the association of colorectal neoplasms (colon adenocarcinoma and colon adenoma) with metabolic syndrome components, non-alcoholic fatty liver disease, and inflammatory markers. Materials and Methods: Data of 151 patients diagnosed with colon adenoma and colorectal adenocarcinoma were retrospectively reviewed. Demographic characteristics, routine blood tests, colonoscopic findings, pathology results, tumor-node-metastasis stages of colorectal adenocancer, and hepatic ultrasonography findings were recorded. The Homeostatic Model Assessment for Insulin Resistance scores were calculated. Results: The study cohort consisted of 71 patients with adenoma and 80 patients with colorectal adenocancer. The number of patients with diabetes mellitus, hypertension, hypertriglyceridemia, metabolic syndrome, severe liver steatosis was significantly higher in the colorectal adenocancer group compared to the colorectal adenoma group. Additionally, neutrophil-lymphocyte ratio, C-reactive protein, and C-reactive protein to albumin ratio were significantly higher in the colorectal adenocancer group compared to the adenoma group. In univariant analysis, patients with diabetes mellitus, hypertension, hypertriglyceridemia, metabolic syndrome, severe liver steatosis were found to have a shorter duration of survival than those who did not have these risk factors. In multivariate analysis, advanced tumor-node-metastasis stage, severe hepatosteatosis, hypertension, and hypertriglyceridemia were found to be independent risk factors for survival of the patients with colorectal adenocancer. Conclusions: Metabolic syndrome, severe liver steatosis, and inflammatory process may be risk factors for the transition from colon adenoma to adenocarcinoma and shorter survival in colorectal cancer patients.

Keywords:

Colorectal adenoma, colorectal adenocarcinoma, insulin resistance, chronic inflammation,

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