Gülen DOĞUSOY, Ahmet DİRİCAN, Süphan ERTÜRK, Yılmaz ERSAN, Yusuf ÇİÇEK, Muhyittin TEMİZ

Mide kanserli hastalarda klinikopatolojik prognostik faktörler

Teşhis ve tedavideki ilerlemelere rağmen mide karsinomu, halen başlıca ölüm sebeplerinden biridir. Biz bu çalışmada, rezektif işlem yapılan olgularda klinikopatolojik faktörlerin 5 yıllık sürvi üzerine olan etkisini inceledik. 1989-1993 yılları arasında cerrahi tedavi geçirmiş tüm hastaların klinik bulguları kayıtlardan elde edildi. Patoloji bulguları ise mevcut histopatolojik slaytlardan ve raporlardan detaylı olarak öğrenildi. İ.Ü.Cerrahpaşa Tıp Fakültesi, Genel Cerrahi Anabilim Dalında, 1989-1993 yılları arasın¬da 409 mide karsinomlu hasta ameliyat edilmiştir. 409 hasta 4 gruba ayrılmıştır. Küratif rezeksiyon grubu (no: 154), palyatif rezeksiyon grubu (no: 124), palyatif gastrojejunostomi (no: 57) ve besleyici ostomi grubu (no=33), laparotomi + biyopsi grubu (no:41). Küratif rezeksiyon geçiren hastaların 5 yıllık sağkalım oranı %58, palyatif rezeksiyon geçirenlerin %12,5 ve non rezektabl tümörlü hastalarınki ise %0'dır. Klinikopatolojik faktörler ve 5 yıllık sağkalım oranlan arasındaki ilişkiler univariate ve multivariate analiz ile değerlendirilmiştir. Küratif rezeksiyon olgularında, 5 yıllık sağkalım logistik regresyon ile multivariate analizi uygulandığı zaman, evre, grade, vaskü-ler/lenfatik/perinöral invazyon tümör invazyon, derinliği, metastatik nodüllerin seviyeleri ve sayıları istatistiksel olarak anlamlı bulunmuştur. Palyatif rezeksiyon olgularında istatistiksel olarak anlamlı tek prognostik faktör metastatik nodüllerin seviyeleridir. Bu çalışma, mide karsinomlu hastalan tedavi eden klinisyenler için en önemli rolün erken teşhis, rezektabl tümörlerin radikal cerrahisi ve detaylı patolojik muayene olduğunu gösterir.

Clinicopathologic prognostic factors in patients with gastric cancer

Background.- Despite recent advances in diagnosis and treatment, gastric carcinoma remains a major cause of death in the world. We evaluated the influence of clinicopathologic variables on 5-year survival rate after gastrectomy. Design.- Clinical characteristics were retrieved from the records of all patients who underwent surgical treatment during 1989-1993. Pathologic characteristics were determined from a detailed review of all available histopathologic slides and reports. Results.- This study is based on an analysis of clinic and pathologicalfeaturesof 409 patients with gastric carcinoma operated on between 1989 and 1993 at Cerrahpaşa Medical Faculty Department of General Surgery. Patients were divided into 4 groups: Curative resection (n=154), palliative resection (n=124), palliative gastrojejunostomy (n=57) or feeding gastrostomy / jejunostomy (n=33), and laparotomy alone (n=41). Five-year survival rate of patients undergoing curative resection, palliative resection and that of patients with non resectable tumor was 58%, 12,5% and 0%, respectively. The relationship between clinicopathologic variables and 5-year survival rate was evaluated by univariate and multivariate analysis. In multivariate analysis with logistic regression of 5-year survival, stage, grade, vascular / lymphatic/ perineural invasion, depth of tumor invasion, levels of metastatic nodes and number of metastatic nodes were statistically significant in cases of curative resection. The only statistically significant independent prognostic factor with long-term survival was levels of metastatic nodes in cases of palliative resection. Conclusion.- This study illustrates that the most important role for clinicians treating patients with gastric carcinoma should be early detection and aggressive surgery for resectable tumors, followed by detailed pathologic examination.

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