Karaciğer, safra kesesi ve safra yolu kanserlerinde epidemiyoloji ve sağ kalım özellikleri

Amaç: Ege Üniversitesi Hastanesinde 1992-2017 arası kanser tanı ve tedavisi yapılan 3791 karaciğer, safra kesesi ve safra yolu kanseri hastasının epidemiyolojik ve sağ kalım özelliklerinin karşılaştırılmasıdır. Gereç ve Yöntem: Ege Üniversitesi Kanserle Savaş Araştırma ve Uygulama Merkezi tarafından toplanan hepatosellüler kanser, intrahepatik ve ekstrahepatik kolanjiosellüler karsinom, safra kesesi ve ampulla Vater tümörleri verileri DSÖ ve SEER sistemleri temelinde gruplanarak analizler yapılmıştır. Tümörlerin yaşam süreleri, farklı evrelerdeki sağ kalım ve yaşam süresi farkları, cinsiyet, yaş ve uygulanan tedavilerin sağ kalım ile ilişkileri araştırılmıştır. Bulgular: 3791 hastadan 1832 hasta hepatosellüler kanser (HSK), 440 hasta intrahepatik kolanjiokarsinoma, 447 hasta ekstrahepatik kolanjiokarsinoma, 540 hasta safra kesesi kanseri ve 532 hasta ampulla Vater kanseri tanısı almıştı. HSK, kolanjiokarsinomlar ve ampulla Vater kanseri erkeklerde, safra kesesi kanseri ise kadın olgularda daha fazla idi. TNM sınıflanmasına göre tüm gruplarda hastaların daha çok ileri evrede olduğu görülmüştür ve en fazla ileri evre hasta olan grup safra kesesi kanserleriydi. Ortalama sağ kalım süreleri HSK için 15 ay, intrahepatik kolanjiokarsinom için sekiz ay, ekstrahepatik kolanjiokarsinom için 10 ay, safra kesesi kanseri için sekiz ay ve ampulla Vater kanseri için 19 ay bulunmuştur. Tedavi modalitelerine göre bakıldığında tüm kanser gruplarında cerrahi tedavi uygulanan hastalarda yaşam süresi daha uzundu. Radyoterapi (RT) uygulamasının sadece safra kesesi kanseri olan hastalarda hayatta kalma üzerine olumlu etkisi bulunmuştur. Kemoterapi (KT) verilmesi intra/ekstrahepatik kolanjiokarsinom ve safra kesesi kanserlerinde hayatta kalmada uzama ile ilişkili bulunurken, HSK ve ampulla Vater kanseri olan hastalarda KT verilen ve verilmeyen hastalar arasında yaşam süresi açısından fark bulunmamıştır. Sonuç: Bu seri 3791 hasta ile hepatobiliyer kanserlerle ilgili Türkiye’de yayınlanmış olan en geniş seridir. Hastalar genelde ileri evrede tanı almaktadır. Cerrahi tedavi tüm gruplarda, RT ve KT ise bazı gruplarda sağ kalım süresinde uzama ile ilişkilidir.

The epidemiological and survival features of liver, gallbladder, and biliary tract cancers

Aim: The aim of this study was to compare the epidemiological and survival features of 3791 liver, gallbladder, and biliary tract cancer patients who were diagnosed and treated between 1992 and 2017 at Ege University Hospital. Materials and Methods: The database of Ege University Cancer Research for liver, gallbladder, and biliary tract cancers were grouped and analyzed based on DSO and SEER systems. Survival time for each tumor, survival times and survival differences for different stages of tumors, and the associations between survival times and the sex, age, and treatment modalities were investigated. Results: Among 3791 cases, 1832 were hepatocellular carcinoma (HCC), 440 were intrahepatic cholangiocarcinoma, 447 were extrahepatic cholangiocarcinoma, 540 were gallbladder cancer, and 532 were ampullary cancer. HCC, cholangiocarcinomas, and ampullary cancer were more common in men; gallbladder cancers were more common in women. According to TNM classification, the patients were in advanced stages in all groups and the most advanced stage patients were in gallbladder cancer group. Median survival times were 15 months for HCC, 8 months for intrahepatic cholangiocarcinoma, 10 months for extrahepatic cholangiocarcinoma, 8 months for gallbladder cancer, and 19 months for ampullary cancer. When survival was evaluated according to treatment modalities, survival was longer in patients treated with surgery in all cancer groups. Radiotherapy (RT) had a positive effect on survival only in patients with gallbladder cancer. Whereas chemotherapy (CT) was associated with survival prolongation in intra/extrahepatic cholangiocarcinoma and gallbladder cancers, there was no survival difference favoring CT administration in patients with HCC and ampullary cancer. Conclusion: This series is the largest of hepatobiliary cancers that was published in Turkey. Patients are usually diagnosed at an advanced stage. Surgical treatment is associated with prolongation of survival in all groups and RT and CT in some groups.

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