Endometrial Karsinomalarda, Mikrosatellit İnstabilite Genlerinin Tümör Evre ve Diferansiasyonu ile İlişkisi

Amaç: Bu çalışmada MSI sonuçları ile hastalara ait yaş, tümör diferansiasyonu, tümör evresi, vasküler invazyon, ve Ki67 proliferasyon gibi faktörlerin arasındaki ilişki ve endometrial karsinom prognozundaki önemi araştırıldı. Yöntemler: Endometrial Kanser (EK) tanısı almış 40 hastanın Total Abdominal Histerektomi (TAH) materyalleri Sancaktepe Prof. Dr. İlhan Varank Eğitim Araştırma Hastanesi Patoloji bölümünde tekrar değerlendirildi. Mikrosatellit instabilite (MSİ)genlerini gösteren immünohisto kimyasal (İHK) (MLH-1, MSH-2, MSH-6 PMS-2) test sonuçları tekrar değerlendirildi. Bu sonuçların, EK tipleri, yaş, tümör evresi, Lenfovaskülerinvazyon (LVİ) ve Ki67 proliferasyon indeksi arasında bir ilişki olup olmadığı araştırıldı. İleri evre EK, LVİ varlığı ile MSİ gen kaybı arasındaki ilişki araştırıldı. Bulgular: Sonuçta erken evre kanserlerde MSİ pozitifliğinin iyi prognostik faktör olarak öne çıktığı görüldü. İleri evre kanserlerde PMS-2 ve MLH-1 ekspresyon kaybının hala kötü prognostik faktör olarak önemini koruduğu dikkati çekti. PMS-2, MLH-1 ve MSH-2 negatiflik oranı; ileri evre EK’lerinde, erken evre kanser hastalarına kıyasla daha yüksek bulunmasına rağmen veriler az sayıda olduğu için sonuçlar anlamlı değildi (p>0.05). Sonuç: PMS-2 ve MLH-1 kayıp oranı LVİ olan hastalarda LVİ olmayan hastalara göre daha yüksek olmasına rağmen istatistiksel olarak anlamlı düzeyde fark oluşturmadı (p>0.05). Erken evreye sahip hastaların yaş ve Ki-67 oranları ileri evredeki hastalara kıyasla daha düşük bulundu (p değerleri sırasıyla; p=0.043, p=0.026). Cerrahi ve patolojik parametrelerin etkileri üzerine daha fazla araştırma yapılmasıyla endometrial karsinomun prognozunda kesin sonuçlar elde edilmesini sağlayacaktır.

Anahtar Kelimeler:

Endometrial karsinom, mikrosatellit instabilite, immünohistokimyasal

Retrospective Comparison of Chemotherapy Plus Anti-HER2 Therapies at First-line Treatment in Patients with Metastatic Gastric Adenocarcinoma

Aim: We aimed to compare the efficacy and the safety of cisplatin plus 5-FU plus trastuzumab and mFOLFOX-6 plus trastuzumab at first-line treatment in HER2-positive metastatic gastric cancer. Method: It was a retrospective observational monocentric study. Patients diagnosed with HER2-positive metastatic gastric adenocarcinoma between January 2013 and December 2020 in Dr AY Ankara Oncology TRH were screened. Patients treated at least one cycle of treatment with either CF-T or mFOLFOX-T were included. Survival outcomes and treatment compliance of patients were compared between groups. Results: Of 52 patients, 55.8% (n=29) of patients were treated with CF-T, and 44.2% (n=23) with mFOLFOX-T. The median age at diagnosis was 60 years (IQR: 52-70) in the CF-T and 64 years (IQR: 59-70) in the mFOLFOX-T groups. De novo metastatic disease comprised 96.6% (n=28) of patients in the CF-T and 69.6% (n=16) in the mFOLFOX-T groups (p=0.016). Both IHC3+ and ISH positivity were observed 82.8% (n=24) of patients in the CF-T and 56.5% (n=13) in mFOLFOX-T groups (p=0.038). The mPFS was 10.4 months (95% CI 8.7-12.2) in the CF-T and 6.5 months (95% CI 5.5-7.6) in the mFOLFOX-T groups (p=0.532). The mOS was 12.2 months (95% CI 11.3-13.2) in the CF-T and 12.5 months (95% CI 9.8-15.5) in the mFOLFOX-T groups (p=0.974). No statistically significant difference regarding at least one dose reduction (31.0% vs 21.7%, p=0.453) and at least one dose delay (24.1% vs 21.7%, p=0.838) was observed between groups. Conclusion: It was revealed that CF-T and mFOLFOX6-T had similar efficacy and tolerability in patients with HER2-positive metastatic gastric adenocarcinoma.

Keywords:

metastatic gastric cancer, anti-HER2, FOLFOX CF, FOLFOX, CF,

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