Ewing sarkomunda prognoz klinik ve histolojik bulgular ile belirlenebilir mi?

Giriş: Ewing sarkomu, osteosarkom ve kondrosarkomdan sonra üçüncü en sık karşılaşılan primer malign kemik tümörüdür. Ewing sarkomunda prognoz, kemoterapinin kullanılmaya başlamasından bu güne kadar, önemli gelişme göstermiştir. Tüm bu gelişmelere rağmen, bazı olguların tedaviye yanıtının yine de kötü olması, hasta ve tümör özelliklerindeki farklılıkların prognozda rol oynadığını düşündürmektedir. Gereç ve Yöntem: İzmir Ege Üniversitesi Tıp Fakültesi Hastanesi Patoloji Anabilim Dalında biyopsi ile Ewing sarkomu tanısı konmuş, klinik takiplerine ulaşılan ve Ewing sarkomu neoadjuvan kemoterapi protokolü olarak POG 8850 protokolü uygulanmış ve tedavi komplikasyonu olmamış 47 olgu prognostik grup olarak çalışmaya alındı. Olguların histolojik ve klinik bulguları değerlendirildi ve bu bulguların yaşam süresine etkisi Kaplan-Meier analizi ile araştırıldı. Bulgular: Buna göre, hastanın 23 yaşından büyük olması (p=0,05), primer tümörün aksiyal iskelet yerleşimli olması (p=0,03), metastazın var olması (p=0,0002), lokal tümör kontrolü için yalnızca radyoterapi uygulanmış olması (p=0,0019), serum LDH düzeyinin tanı anında yüksek olması (p=0,018) ve neoadjuvant kemoterapi öncesinde alınan biyopside spontan nekrozun %50'nin üzerinde olması (p=0,02) parametrelerinin kötü prognoz ile ilişkili olduğu saptandı. Cinsiyet, hastaların hekime başvurmadan önceki yakınma süresi, tanı anında metastazın bulunması, metastazlara uygulanan tedavi yöntemlerindeki farklılık, yüksek serum ALP düzeyi, tümör hücrelerinde sitoplazmik sınırların belirginliği, nükleer sınırların düzensizliği, nükleer kromazi, nukleol varlığı, sitoplazmik glikojen yoğunluğu, retikulum ağının dağılımı, mitoz sayısı gibi parametrelerin prognostik bir önemi olmadığı bulundu. Tartışma: Önümüzdeki yıllarda, olguların klinik ve histolojik farklılıklarını ortaya çıkaran kıstasların saptanmasıyla yeni tedavi modellerinin şekillenmesi ve bağlantılı olarak prognozun olumlu yönde etkilenmesi hedeflenmektedir.

May the prognosis of Ewing sarcoma be defined by clinical and histological findings?

Introduction: Ewing Sarcoma is the third most common primary malign bone tumor after osteosarcoma and chondrosarcoma. Up to date, prognosis of Ewing sarcoma has been greatly improved by the use of chemotherapy. The fact that there are still cases which don't respond well to chemotherapy despite the progress in treatment models, make us think that differences in the features of patients and tumors have a certain role in prognosis. Materials and Methods: Forty seven cases of Ewing sarcoma diagnosed by biopsy and treated with POG # 8850 chemotherapy protocol at Ege University, Department of Pathology were included in the study. Histological and clinical findings of all cases were evaluated and their relations with survival time are investigated by Kaplan-Meier analysis. Results: According to the results, age older than 23 years, axial localization of the primary tumor, presence of metastasis, previous treatment only by radiotherapy, high LDH values at the time of diagnosis and spontaneous necrosis present in more than 50% of the biopsy material obtained before chemotherapy were the parameters found to be related with poor prognosis. On the other hand, parameters such as sex, the time spent before admission, presence of metastasis at the time of diagnosis, differences in treatment regimens used for metastasis, serum ALP values, cytoplasmic limits of the tumor cells, irregularity of nuclear limits, nuclear hyperchromosia, concentration of cytoplasmic glycogen, distribution of the reticulum network and number of mitosis didn't show prognostic importance. Discussion: In the upcoming years, the aim is to find the criteria that reveal the clinical and histopathological differences in patients and design new treatment models in order to reach better prognosis in our patients.

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