Ali YILMAZ, Tunahan UNCU, Turgut KAÇAN, Nalan BABACAN AKGÜN, Saadettin KILIÇKAP, Mehmet ŞEKER METİN, Birsen YÜCEL

Non-metastatik mide kanserli olgularda prognostik faktörler

Amaç. Mide kanseri kansere bağlı ölümlerin en sık nedenlerinden biridir. Prognostik faktörlertedavi kararını etkileyebilir. Bu retrospektif çalışmada merkezimizde takip edilen non-metastatikmide kanseri olgularda prognostik faktörlerin belirlenmesi amaçlandı. Yöntem. Hasta verilerihasta dosyası ve hastane kayıtlarından elde edildi. Demografik veriler ve patolojik bulgulartoplanarak veri tabanına kaydedildi. Tümör ve hastaya ait prognostik faktörlerin yanı sıra,laboratuvar parametreleri incelendi. Bulgular. Çalışmada 2009-2011 tarihleri arasındabölümümüze başvuran mide kanseri tanısı almış 120 hastanın verileri analiz edildi. Olguların yaşortalaması 60±11 iken, hastaların 92si (%77) erkek idi. Mide tümörü %78inde (n=93) distalyerleşimli idi. En sık görülen evre %71 ile evre 3 idi. Tüm olguların %62sinde lenfovaskülerinvazyon pozitif idi. Olguların %44ü kötü diferansiye tümör idi. En sık ECOG performans skoru0 (%64) görüldü. Ortanca tümör çapı 5 cm (1-15) idi. Ortanca çıkarılan lenf nodu sayısı 20 (2- 54) iken, ortanca tutulmuş lenf nodu sayısı 5 (0-44) idi. Yüzde seksen hastada lenf nodu tutulumumevcuttu. Ortanca izlem süresi 22 ay idi. Üç yıllık sağkalım oranları evre arttıkça azalmaktaydı.CEA yüksekliği, evre, lenf nodu tutulumu, performans skoru, ekstralenfatik yayılım ve anemisağkalımı etkileyen faktörler idi. CEA yüksekliği ve evre sağkalımı etkileyen bağımsızdeğişkenlerdi. Sonuç. Non-metastatik mide kanserinde evre ve CEA yüksekliği sağkalımıbağımsız olarak etkilemektedir.

Prognostic f actors in patients with non-metastatic gastric cancer

Aim. Gastric cancer is one of the leading causes of cancer-related deaths. The prognostic factorsmay affect decision of the treatment. In this retrospective study, we aimed to determine prognosticfactors for non-metastatic gastric cancer in patients who were followed-up in our centre. Method.The data were obtained from patients file and the hospital records. The demographic parametersand pathological findings of the patients were recorded at the database. In addition to thelaboratory tests of all patients, tumor,-and patient-related prognostic factors were also evaluated.Result. Data of 120 patients with gastric cancer at followed-up in our department between 2009and 2011 were analyzed in this study. The mean age of the patients was 60±11, and 92 (77%) weremale. Seventy-eight percent of gastric cancer (n=93) were localized in the distal. The mostcommon occurred stage was stage 3 (71%). Of patients, lymphovascular invasion was 62% and44% had poorly differentiated tumor. The most common performance status was ECOG 0(64%). The median tumor size was 5 cm (1-15 cm). The number of median excised lymph nodewas 20 (2-54) and the median involved lymph node was 5 (0-44). Eighty percent of patients werelymph node positive. The median follow-up period was 22 months. The 3-year survival rates weredecreasing according to stage. CEA elevation, stage, node involvement, performance status,extralymphatic extension, and anemia were prognostic factor for survival. CEA and the stage ofdisease were independently prognostic factors for survival. Conclusion. Stage and higher CEAindependently affect survival in non-metastatic gastric cancer.

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1. World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization 2008.
2. Eser S, Yakut C, Özdemir R, Karakilinç H, Özalan S, Marshall SF, Karaoğlanoğlu O, Anbarcioğlu Z, Üçüncü N, Akin Ü, Özen E, Özgül N, Anton- Culver H, Tuncer M. Cancer incidence rates in Turkey in 2006: A detailed registry based estimation. Asian Pac J Cancer Prev 2010; 11: 1731-9.
3. Kılıçkap S, Tapan Ü, Yalçın Ş. Metastasis to bone from gastric cancer: a single centre experience. Cumhuriyet Med J 2010; 32: 192-8.
4. Sánchez-Bueno F, Garcia-Marcilla JA, Perez-Flores D, Pérez-Abad JM, Vicente R, Aranda F, Ramirez P, Parrilla P. Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection. Br J Surg 1998; 85: 255-60.
5. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 15; 127: 2893-917.
6. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004; 1; 22: 2069-77.
7. Pacelli F, Papa V, Caprino P, Sgadari A, Bossola M, Doglietto GB. Proximal compared with distal gastric cancer: multivariate analysis of prognostic factors. Am Surg 2001; 67: 697-703.
8. Baba H, Maehara Y, Takeuchi H, Inutsuka S, Okuyama T, Adachi Y, Akazawa K, Sugimachi K. Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer. Surgery 1995; 117: 165-9.
9. Adachi Y, Ogawa Y, Sasaki Y, Yukaya H, Mori M, Sugimachi K. A clinicopathologic study of gastric carcinoma with reference to age of patients. J Clin Gastroenterol 1994; 18: 287-90.
10. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 1995; 82: 346-51.
11. Kitamura K, Yamaguchi T, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997; 64: 42-7.
12. Maehara Y, Kakeji Y, Koga T, Emi Y, Baba H, Akazawa K, Sugimachi K. Therapeutic value of lymph node dissection and the clinical outcome for patients with gastric cancer. Surgery 2002; 131: S85-91.
13. Siewert JR, Böttcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228: 449-61.
14. Adachi Y, Shiraishi N, Suematsu T, Shiromizu A, Yamaguchi K, Kitano S. Most important lymph node information in gastric cancer: multivariate prognostic study. Ann Surg Oncol 2000; 7: 503-7.
15. Duraker N, Sişman S, Can G.The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma. Surg Today 2003; 33: 95- 100.
16. Scartozzi M, Galizia E, Verdecchia L, Berardi R, Graziano F, Catalano V, Giordani P, Mari D, Silva RR, Marmorale C, Zingaretti C, Cascinu S. Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients. Br J Cancer 2006; 95: 445-9.
17. Mihmanli M, Dilege E, Demir U, Coskun H, Eroglu T, Uysalol MD. The use of tumor markers as predictors of prognosis in gastric cancer. Hepatogastroenterology 2004; 51: 1544-7.
18. Shen JG, Cheong JH, Hyung WJ, Kim J, Choi SH, Noh SH. Pretreatment anemia is associated with poorer survival in patients with stage I and II gastric cancer. J Surg Oncol 2005; 91: 126-30.
19. .Kanagavel D, Pokataev IA, Fedyanin MY, Tryakin AA, Bazin IS, Narimanov MN, Yakovleva ES, Garin AM, Tjulandin SA. A prognostic model in patients treated for metastatic gastric cancer with second-line chemotherapy. Ann Oncol 2010; 21: 1779-85.
20. Navaneethan U, Beg MS, Komrokji R, Safa MM. Characteristics of proximal versus distal gastric cancer at the VA: Is there a difference? J Clin Oncol (Meeting Abstracts) 2008; 26: suppl 15517.
21. Piso P, Werner U, Lang H, Mirena P, Klempnauer J. Proximal versus distal gastric carcinoma--what are the differences? Ann Surg Oncol 2000; 7: 520-5.
22. Saito H, Kuroda H, Matsunaga T, Fukuda K, Tatebe S, Tsujitani S, Ikeguchi M. Prognostic indicators in node-negative advanced gastric cancer patients. J Surg Oncol 2010; 101: 622-5.