Ali YILMAZ, Mehmet BİLİCİ, Salim Başol TEKİN

Prostat Kanserli Hastalarda Sağkalım Analizi ve Prognostik Faktörler: Doğu Anadolu Tek Merkez Deneyimi

Amaç: Ürogenital traktın sık görülen malignitelerinden biri olan prostat kanseri (PK) özellikle ileri yaş erkeklerde daha yaygındır ve bireyler arasında önemli prognoz farklılıkları göstermektedir. Son yıllarda prognozu öngörmek için yeni grade grupları ve Amerikan Kanser Komitesi (AJCC) evre grupları kullanılmaya başlanmıştır. Ancak ülkemizde PK’lı hastalarda bu yeni sistemin prognostik önemini gösteren bilgiler sınırlıdır. Bizde bu çalışmada ülkemiz Doğu Anadolu Bölgesinde PK tanısıyla takip edilen hastaların hem takip sonuçlarını hem de yeni prognostik evreleme sisteminin klinik önemini ortaya koymayı amaçladık. Yöntemler: Erzurum Atatürk Üniversitesi Tıp Fakültesi Tıbbi Onkoloji Bilim Dalı'nda PK tanısıyla takip edilen 141 hasta çalışmaya retrospektif olarak dahil edildi. Genel sağkalım (OS) ve progresyonsuz sağkalım (PFS) ile klinik-patolojik parametreler arasındaki ilişkiler Kaplan-Meier eğrileri kullanılarak analiz edildi ve log-rank testi ile karşılaştırıldı. Tek ve çok değişkenli analiz klinik-patolojik değişkenlerin PFS ve OS için prognostik önemlerini belirlemekte kullanıldı. Bulgular: Çalışmadaki hastaların medyan yaşı 69’du ve çoğunluğunu evre IV (%79,4) vakalar oluşturuyordu. Hastaların medyan prostat spesifik antijen (PSA) değeri 39 ng/mL, medyan Gleason skoru ise 8’di. Çalışmada PSA değeri ≥ 20 ng/mL (%61,7) olan ve Gleason grade grubu 5 (%35,5) olan hastalar çoğunluktaydı. Medyan PFS 29 ay ve medyan OS 33 aydı, 5 yıllık yaşam oranları lokallokorejyonel hastalık için %50, metastatik hastalık için %20 idi. ECOG performans durumu iyi olanların (0-1), cerrahi yapılanların, erken evrede (I-II) olanların, düşük PSA’sı (< 10 ng/mL) olanların ve Gleason grubu düşük olanların (1-2) PFS ve OS’si daha uzundu. Multivariate analizde evre, PSA ve Gleason grade grubu hem PFS hem de OS için bağımsız prognostik faktör olarak bulundu. Sonuç: PK’lı hastalarda yeni grade sistemi, PSA ve AJCC evreleme sistemi bağımsız prognostik faktörlerdir. Bölgemizdeki hastaların dünya geneline göre daha kısa yaşam sürelerine sahip oldukları göz önünde bulundurulduğunda hastaların tedavi stratejisini belirlemede bu prognostik faktörler günlük pratikte daha etkin olarak kullanılmalıdırlar.

Survival Analysis and Prognostic Factors in Prostate Cancer Patients: A Single Center Experience in Eastern Anatolia

Objective: Prostate cancer (PC), one of the most common malignancies of the urogenital tract, is more common in older men and shows significant prognostic differences among individuals. In recent years, new grade groups and American Joint Committee on Cancer (AJCC) stage groups have been used to predict prognosis. However, there is limited information on the prognostic significance of this new system in PC patients in Turkey. In this study, we aimed to evaluate the follow-up results of patients with diagnosis of PC, and the clinical significance of the new prognostic staging system in this patient population in Eastern Anatolia Region.Methods: Retrospectively, 141 PC patients being followed up in Erzurum Ataturk University of Medical Oncology Department were included in this study. The relationships between overall survival (OS) and progression free survival (PFS) and clinical-pathological parameters were analysed using Kaplan-Meier curves and compared with the log-rank test. Univariate and multivariate analysis were used to determine the prognostic significance of clinical and pathologic variables for PFS and OS.Results: The median age of patients was 69 and the majority of them were stage IV patients (79.4%). The median value of prostate specific antigen (PSA) was 39 ng/mL and the median Gleason score was 8. The majority of the patients had PSA value of ≥ 20 ng / ml (61.7%) and Gleason grade group 5 (35.5%). The median PFS and OS values were 29 and 33 months, respectively. The 5-year survival rates were 50% for local-locoregional disease and 20% for metastatic disease. PFS and OS were longer in patients with good Eastern Cooperative Oncology Group (ECOG) performance status (0-1), early stage (I-II), undergone to surgery, having low PSA (< 10 ng / ml) and low Gleason group (1-2). According to the multivariate analysis; stage, PSA and Gleason grade group were independent prognostic factors for both PFS and OS.Conclusion: The new grading system, PSA and AJCC staging system are independent prognostic factors in patients with PC. Considering that patients in our region have shorter life spans compared to the world, these prognostic factors should be used more effectively in daily practice in determination of treatment strategy.

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