Nihat Zafer UTKAN, Nuh Zafer CANTÜRK, Sertaç Ata GÜLER, Alican GÜREŞİN, Turgay ŞİMŞEK, Neşet Nuri GÖNÜLLÜ

Mide Kanserinin Operabilite ve Anrezektabilitesini Belirlemede Tümör Belirteçleri

Giriş/Amaç: Mide kanseri en sık 50 yaşın üzerindeki hastalarda görülür ve prognozu kötüdür. Cerrahi tedaviler mide kanserinin önde gelen tedavi yöntemleridir. Bu tümörler cerrahi değerlendirmelerine göre operabl, rezektabl, inoperabl ve anrezektabl olarak sınıflandırılır. Tümör belirteçleri özellikle prognoz ve takiplerde rol oynar. Gereç ve Yöntemler: Kliniğimizde klinik olarak operabl mide kanseri tanısı alan ve ameliyat edilen 80 hastanın retrospektif incelemesi yapıldı. Hastaların doğum tarihleri, cinsiyetleri ve neoadjuvan tedavi bilgileri kaydedildi. Tümörlerin mide içerisindeki lokalizasyonu endoskopik ve radyolojik olarak belirlendi. Lokalizasyonlar üç kategoriye ayrıldı: Proksimal, orta ve distal. Bulgular: Çalışmaya 80 hasta alındı ve bunlar geriye dönük olarak incelendi. Bunların 20’si kadın, kalan 60’ı erkekti. Hastaların yaş ortalaması 61,21 (± 12,37) olarak belirlendi. Hastaların 28'i neoadjuvan bir tedavinin ardından cerrahi olarak tedavi edildi ve diğer 52 hastaya ameliyatlardan önce neoadjuvan tedavi uygulanmadı. Sonuç: CEA ve CA19-9 düzeyleri ile mide kanseri hastalarının uygun tedavi seçeneği, operabilite veya anrezektabilite durumları arasında anlamlı bir ilişki saptanmadı. Çalışmamızın retrospektif ve az sayıda hastada yapılmış olması ile ilgili olabileceği düşünüldü. Ayrıca daha yüksek hasta popülasyonuyla yapılacak bir çalışmada CA19-9 seviyeleri bu amaç için daha değerli olabilir.

Tumor Markers in Determining Operability and Unresectability of Gastric Cancer

Objective: Gastric cancer is most commonly seen in patients over 50 years old and its prognosis is poor. Surgical treatments are leading treatment methods of gastric cancers. These tumors are classified as operable, resectable, inopera- ble and nonresectable regarding their surgical evaluation. Tumor markers play a role, particularly for prognosis and follow-ups. In some instances, it is only understood that patients were actually inoperable or nonresectable during surgeries. Material and Methods: A retrospective investigation was performed of 80 patients who were clinically diagnosed with operable gastric cancer and underwent surgery in our clinic. Patients’ birth dates, genders and past medical histories of neoadjuvant therapy were recorded. Localizations of tumors inside stomach were determined endoscopically and radiologically. Localizations were classified into three categories: proximal, middle and distal. Results: There were 80 patients who were included in the study and they were reviewed retrospectively. 20 of them were females and remaining 60 patients were males. Mean value of patients ages were determined as 61,21 (± 12,37). 28 of the patients were treated surgically following a neoadjuvant therapy and other 52 patients did not receive a neoadjuvant therapy prior to surgeries. Conclusion: There was no significant relationship between CEA and CA19-9 levels and the appropriate treatment options, opera- bility or unresectability of gastric cancer patients. This may be due to the retrospective nature of our study and the low number of patients included. In addition, CA19-9 levels may be more valuable for this purpose in a study with a higher patient population.

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1) Sugarbaker PH, Yu W, Yonemura Y. Gastrectomy, peritonectomy, and perioperative Intraperitoneal chemotherapy: the evolution of treatment strategies for advanced gastric cancer. Semin Surg Oncol. 2003; 21(4):233-48.
2) Sugarbaker PH, Yonemura Y. Clinical pathway for the management of resectable gastric cancer with peritoneal seeding: best palliation with a ray of hope for cure. Oncology. 2000; 58(2):96-107.
3) Glehen O, Gilly FN, Arvieux C, Cotte E, Boutitie F, Mansvelt B, Bereder JM, Lorimier G, Quenet F, Elias D; Association Française de Chirurgie. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010; 17(9):2370-7.
4) Yonemura Y, Bandou E, Kinoshita K, Kawamura T, Takahashi S, Endou Y, Sasaki T. Effective therapy for peritoneal dissemination in gastric cancer. Surg Oncol Clin N Am. 2003; 12(3):635-48.
5) Yu W, Whang I, Suh I, Averbach A, Chang D, Sugarbaker PH. Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer. Ann Surg. 1998; 228(3):347-54.
6) Esfahani A, Somi MH, Asghari Jafarabadi M, Ostadrahimi A, Ghayour Nahand M, Fathifar Z, Doostzadeh A , Ghoreishi Z. New score for screening of malnutrition in patients with inoperable gastric adenocarcinoma. Japanese Journal of Clinical Oncology. 2017; 47(6):475-9.
7) Qiao YF, Chen CG, Yue J, Ma MQ, Ma Z, Yu ZT. Prognostic significance of preoperative and postoperative CK19 and CEA mRNA levels in peripheral blood of patients with gastric cardia cancer. World Journal of Gastroenterology. 2017; 23(8):1424-33.
8) Baretton GB, Aust DE. Current biomarkers for gastric cancer. Pathologe. 2017; 38(2):93-7.
9) Yu J, Zheng W. An Alternative Method for Screening Gastric Cancer Based on Serum Levels of CEA, CA19-9, and CA72-4. J Gastrointest Cancer. 2018; 49(1):57-62.
10) Chiu CF, Yang HR, Yang MD, Jeng LB, Yang TY, Sargeant AM, Bai LY. Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study. Gastroenterol Res Pract. 2016; 2016:6846027.
11) Wada N, Kurokawa Y, Miyazaki Y, Makino T, Takahashi T, Yamasaki M, Nakajima K, Takiguchi S, Mori M, Doki Y. The characteristics of the serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels in gastric cancer cases. Surg Today. 2017; 47(2):227-32.
12) Liang Y, Wang W, Fang C, Raj SS, Hu WM, Li QW, Zhou ZW. Clinical significance and diagnostic value of serum CEA, CA19-9 and CA72-4 in patients with gastric cancer. Oncotarget. 2016;7(31):49565-73.