İlke Evrim SEÇİNTİ, Didar GÜRSOY, Tümay ÖZGÜR, Emre DİRİCAN, Muhyittin TEMİZ

Safra kesesi adenokarsinomunda tümör tomurcuklanması, tümör stroma oranı ve tümörü infiltre eden lenfositlerin prognostik önemi

Amaç: Tümör mikroçevresi kanserin başlangıcında ve ilerlemesinde önemli rol oynar. Tümör tomurcuklanması (TB), tümör stroması ve tümörü infiltre eden lenfositler, tümör mikroçevresinin bileşenleridir. Bu çalışmada safra kesesi adenokarsinomunda TB, tümör stroma oranı (TSR) ve tümörü infiltre eden lenfositlerin (TILs) klinikopatolojik prognostik parametrelerle ilişkisinin belirlenmesi amaçlandı. Gereç ve yöntem: 2010-2020 yılları arasında adenokarsinom tanısı alan, neoadjuvan tedavi almayan ve arşiv preparatlarına ulaşılabilen 30 kolesistektomi olgusu çalışmaya dahil edildi. TB, TSR ve TILs değerlendirildi. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Yüksek TB skoru, daha yüksek histolojik derece (p=0,008), daha yüksek pT evresi, lenfovasküler invazyon (LVI) (p=0,038), lenf nodu metastazı (p=0,046) ve uzak metastaz (p=0,036) ile anlamlı ilişkiliydi. TB skoru yüksek olan hastaların genel sağkalım süreleri daha kısaydı (p<0,001). Yüksek TILs grubunda, daha düşük histolojik derece (p=0,004), daha az LVI (p=0,029), daha az uzak metastaz (p=0,021) ve daha düşük TSR (p=0,008) saptandı. Yüksek TSR, daha yüksek histolojik derece (p=0.015) ve artan uzak metastaz (p=0.013) ile ilişkilendirildi. TSR'nin genel sağkalım üzerinde anlamlı bir etkisi yoktu (p=0,239). Sonuç: TB, safra kesesi kanserli hastalarda yeni bir prognostik histolojik özellik olarak kullanılabilir. Safra kesesi kanserlerinde prognostik göstergeler olarak TILs ve TSR'yi önermek için erken olduğu kanaatindeyiz. Gelecekte, TILs ve TSR'nin prognostik değerini netleştirmek için çok merkez katılımlı daha fazla sayıda GBC vakası üzerinde çalışmalar yapılabilir.

Anahtar Kelimeler:

Safra kesesi kanseri, Prognoz, Stroma, Tümör tomurcuklanması, Tümörü infilte eden lenfosit

The prognostic significant of tumor budding, tumor stroma ratio and tumor-infiltrating lymphocytes in gallbladder adenocarcinoma

Aim: Tumor microenvironment plays an important role in onset and progression of the cancer. Tumor budding (TB), tumor stroma and tumor-infiltrating lymphocytes are component of the tumor microenvironment. It was aim to determine the relationship of TB, tumor stroma ratio (TSR) and tumor-infiltrating lymphocytes (TILs) with clinicopathological prognostic parameters in gallbladder adenocarcinoma. Materials and Methods: Thirty cholecystectomy cases that were diagnosed as adenocarcinoma between 2010 and 2020, that did not receive neoadjuvant therapy and of which archive slides could be accessed, were included in the study. TB, TSR and TILs were evaluated. A p<0.05 value was statistically significant. Results: High TB score was significantly associated with higher histological grade (p=0.008), higher pT stage, lymphovascular invasion (LVI) (p=0.038), lymph node metastasis (p=0.046) and distant metastasis (p=0.036) . Patients with high TB scores had a shorter overall survival (p<0.001). In the high TILs group, lower histological grade (p=0.004), less LVI (p=0.029), fewer distant metastases (p=0.021) and lower TSR (p=0.008) were detected. Increased TCR was associated with higher histological grade (p=0.015) and increased distant metastasis (p=0.013). There was no significant effect of TCR on overall survival (p=0.239). Conclusion: TB can be used as a novel prognostic histological characteristic in the gallbladder cancer patients. We have concluded that it is early to recommend TILs and TSR as the prognostic indicators in gallbladder cancers. In the future, further studies can be conducted on a larger number of GBC cases with a multicenter participation to clarify the prognostic value of TILs and TSR.

Keywords:

Gallbladder cancer, Prognosis, Stroma, Tumor budding, Tumor-infiltrating lymphocyte,

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