Kolorektal Kanserlerde Metastatik Lenf Nodu Tutulumu ile İlişkili Faktörler

GİRİŞ ve AMAÇ: Metastatik lenf nodu (MLN) sayısı birçok kanserde hastalıksız ve genel sağkalımı etkileyen en önemli prognostik faktördür. Bu çalışmada kolorektal kanserlerde (KRK) metastatik lenf nodu tutulumu ile ilişkili faktörleri ideledik. YÖNTEM ve GEREÇLER: Çalışmaya 2016-2021 yılları arasında küratif cerrahi uygulanan 192 kolorektal kanser hastası dahil edildi. Adenokanser dışı başka tanısı olan, verilerine ulaşılmayan hastalar ve acil vakalar çalışma dışı bırakıldı. Hastalar lenf nodu tutulumuna göre 4 gruba ayrıldı. Bu 4 gruba göre hastalar yaş, cinsiyet, T stage, tümör evresi, histopatolojik grade, tümör lokalizasyonu, lenfovasküler invazyon(LVİ), perinöral invazyon (PNİ), NLO (Nötrofil/lenfosit oranı), LMO (Lenfosit/monosit oranı), monosit sayısı, total lenf nodu sayısı gibi parametreler açısından karşılaştırıldı. BULGULAR: Çalışmaya dahil edilen 192 hastanın 75’i (%39.06) kadın, 117’si (%60,94) erkekti. Ortalama yaş 67 (23: 89) ve ortalama takip süresi 20 (2: 63) ay idi. Metastatik lenf nodu tutulumuna göre N0, N1, N2a ve N2b hasta sayısı sırasıyla 101, 57, 20, 14 idi. Metastatik lenf nodu tutulumu ile yaş, cinsiyet NLO, LMO arasında anlamlı bir ilişki bulunmadı. Metastatik lenf nodu sayısı arttıkça sağ kalım azalmaktadır.( p=0.002). Histopatolojik grade, t evresi, LVİ, PNİ, artmış tümör çapı, çıkartılan total lenf nodu sayısı ve artmış monosit sayısı metastatik lenf nodu tutulumu ile anlamlı olarak ilişkili bulundu. TARTIŞMA ve SONUÇ: Çalışmamızda standart prognostik faktörler haricinde artmış monosit sayısı lenf nodu tulumu ile ilişkili bulundu. Minimal invaziv cerrahi planlanan veya evre Ⅱ hastalarda monosit sayısı yüksek olması durumunda ihtiyatlı davranmak gerektiğini ve tedavi planın buna göre yapılmasını öneriyoruz.

Anahtar Kelimeler:

Kolorektal kanser, lenf nodu tutulumu, prognostik faktörler

Associated Factors of The Metastatic Lymph Node Involvement in Colorectal Cancers

INTRODUCTION: The number of Metastatic Lymph Nodes [MLN] is the most important prognostic factor that affects disease-free and overall survival in many cancer types. In the study, the factors associated with metastatic lymph node involvement were investigated in Colorectal Cancers [CRC]. METHODS: A total of 192 colorectal cancer patients who underwent curative surgery between 2016 and 2021 were included in the study. Patients who had a diagnosis other than adenocarcinoma, whose data could not be obtained and emergency cases were excluded from the study. According to these 4 groups, patients were compared in terms of parameters such as age, gender, T stage, tumor stage, histopathological grade, tumor localization, Lymphovascular Invasion [LVI], Perineural Invasion [PNI], NLR [Neutrophil/Lymphocyte Ratio], LMO [Lymphocyte/Monocyte Ratio], monocyte count, and the total number of lymph nodes. RESULTS: Among the 192 patients included in the study, 75 (39.06%) were female, and 117 [60.94%] were male. The mean age was 67 [23: 89], and the mean follow-up time was 20 [2: 63] months. According to metastatic lymph node involvement, the number of N0, N1, N2a, and N2b patients was 101, 57, 20, 14, respectively. No significant relations were detected between metastatic lymph node involvement and age, gender, NLR, and LMO. As the number of metastatic lymph nodes increased, survival rates decreased [p=0.002]. Histopathological grade, t stage, LVI, PNI, increased tumor diameter, the total number of lymph nodes removed, and increased monocytes were found to be significantly associated with metastatic lymph node involvement DISCUSSION AND CONCLUSION: n the present study, except for standard prognostic factors, increased monocytes were associated with lymph node enlargement. In the case of high monocyte counts in patients who are scheduled for minimally invasive surgery or in Stage Ⅱ, we suggest that caution should be exercised, and the treatment plan should be made accordingly.

Keywords:

Colorectal cancer, lymph node involvement, prognostic factors,

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