Tolga Önder, Aras Emre Canda, Cihan Heybeli, Hülya Ellidokuz, Cem Terzi, Mehmet Füzün

Lokal İleri Rektum Kanseri Hastalarında Neoadjuvan Tedavi Öncesi Serum Karsinoembriyonik Antijen Düzeylerinin Neoadjuvan Tedaviye Yanıtı Öngördürücülüğü

Amaç: Çalışmamızda lokal ileri evre rektum kanseri tanısı alan hastalarda, neoadjuvan tedavi öncesi serum Karsionoembriyonik Antijen (CEA) düzeyleri ile neoadjuvan tedaviye yanıt ölçütleri arasındaki birlikteliği değerlendirmeyi amaçladık.Gereçler ve Yöntem: 1993-2009 yılları arasında lokal ileri rektum kanseri tanısı alıp takipleri Dokuz Eylül Üniversitesi Tıp Fakültesi’nde yapılan 138 hasta incelendi. Tüm hastalara toplam 45-50 Gy dozunda (20-25 günde) preoperatif radyoterapi uygulandı ve eş zamanlı 5-Fluorouracil (225mg/m2/gün, haftanın 5 günü) kemoterapisi verildi. Neoadjuvan tedavi sonrası 6-8 hafta içerisinde hastalar total mezorektal eksizyon tekniği ile opere edildi. Neoadjuvan tedavi öncesi hastalardan çalışılan serum CEA düzeyleri, neoadjuvan tedaviye yanıt ölçütleri ile birlikte değerlendirildi.Bulgular: Ortalama izlem süresi 42 ay olan hastaların ortalama yaşının 58 ± 13 ve 89 (%64,5)’unun erkek olduğu belirlendi. Preoperatif evrelerine bakıldığında, 24’ü evre II (%17,4), 114’ü evre III (%82,6) olarak bulundu. 83 (%60,1) hastaya sfinkter Koruyucu Cerrahi (SKC) yapılırken diğer hastalara Abdominoperineal Rezeksiyon (APR) uygulandı. Postoperatif 8 (%5,8) hastada patolojik tam yanıt saptandı. Hastaların 86’sında (%62,3) neoadjuvan tedavi sonrası evre gerilemesi saptandı. Ortalama CEA değeri 11,1 ± 23,6 ng/ml (dağılım; 0,32-202ng/ml) idi. 74 hastanın (%53,6) CEA düzeyi ≤5 ng/ml olarak kaydedildi. İzlemde 19 hastada lokorejyonel nüks saptandı. Neoadjuvan tedavi öncesi CEA düzeyi 3,5 ng/mL altında olan hastalarda lokorejyonel nüks sıklığı istatistiksel olarak anlamlı şekilde daha düşüktü. Neoadjuvan tedaviye yanıtlılarda genel sağ kalım 127±13 ay (p<0,001), hastalıksız sağ kalım 99,9 ± 11,2 ay (p<0,001) olarak hesaplandı. Tartışma ve sonuç: Tedavi öncesi ≤3,5 ng/ml CEA değeri neoadjuvan tedaviye yanıt konusunda fikir verebilir.

Anahtar Kelimeler:

karsinoembriyonik antijen, kolorektal kanser

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