Meral KOYUNCUOĞLU, MUSTAFA PEHLİVAN, SACİDE PEHLİVAN, Ziya KIRKALI

Böbreğin renal hücreli kanserlerinde prognostik faktörlerden cathepsin D1 ekspresyonu ve genetik heterojenitenin önemi

Renal hücreli kanserler (RHK) davranışları bakımından diğer insan kanserlerinden çok farklı olan tümörlerdir. Klinik gidişi belirlemede en önemli prognostik faktörler (PF) tümörün evresi ve nükleer derecesidir. Diğer tümörlerde cathepsin D1 (CD) ekspresyonunun prognostik önemi tartışmalı olup pek çok çalışmada kötü PF olduğu vurgulanmasına karşın RHK'lerde CD ekspresyonu ve genetik heterojenitenin (GH) prognostik önemi çalışılmamıştır. Bu çalışmada; radikal nefrektomi uygulanarak RHK tanısı alan ve düzenli kontrollere gelen 48 olgu değerlendirilmiştir. Olguların medyan yaşı 56.5 (31-78), 28'i erkek, 20'si kadın ve medyan takip süresi 51 aydır. PF olarak 18 farklı klinik ve laboratuar parametresi değerlendirildiğinde; univariate analizde CD ekspresyonu ve ileri evre, 5 yıllık sağkalım olasılığını belirgin şekilde olumsuz etkileyen önemli birer PF olarak saptanmıştır (p=0.046, p=0.021). Ayrıca mitokondrial RNA işlenmesinde ve DNA tamirinde görevli enzimleri kodlayan bölgeye yakın seçilen mikrosatellit D9S157'de GH saptanan grupta istatiksel olarak anlamlı olmasa da 5 yıllık sağ kalım olasılığı daha kısa bulunmuştur. Hastaların prognozu hakkında tahminde bulunurken hastalığın yaygınlığı, performans durumu gibi bilinen faktörlerin yanı sıra CD'de göz önüne alınmalıdır.

Anahtar Kelimeler:

Genetik, Katepsin D, Karsinom, renal hücreli, Seyir, Neoplazm evrelendirilmesi

Importance of cathepsin D1 and genetic heterogeneity from prognostic factors in renal cell carcinoma

Renal cell carcinomas (RCC) are tumors, which are very different from other human cancers in terms of their de meanor. The most important prognostic factors in the clinical evaluation are tumor stage and nuclear grade. In other tumors, the prognostic importance of cathepsin D1 (CD) expression is controversial. In most studies, though stressed to be bad prognostic factor, CD and genetic heterogeneity (GH) as a prognostic factor in RCC have not been studied. In this study 48 cases under regular control with a diagnosis of RCC by radical nephrectomy were examined. Their median age was 56.5 (31-79); 28 were men (58%). The period of median follow-up is 51 months. When 18 different clinical and laboratory parameters were evaluated as prognostic factor in univariate analysis, CD and advanced stage were found to be significant prognostic factor affecting 5-yr survival rate negatively (p=0. 046, p=;0. 021). Furthermore, in the group in which GH was found in microsatellite D9S157, close to the area coding the enzymes responsible for RNA processing and DNA repairing, the 5- year survival rate, though statistically insignificant, was found to be shorter. In conclusion, in addition to commonly known prognostic factor, like extend of disease and performance status, we should also consider CD in predicting prognosis.

Keywords:

Genetics, Cathepsin D, Carcinoma, Renal Cell, Prognosis, Neoplasm Staging,

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