Neoadjuvan kemoterapi uygulanan opere lokal ileri evre mide kanseri hastalarında nüksü öngören faktörler

Amaç: Neoadjuvan kemoterapi, tümör rezeksiyon oranlarını arttırmak, metastazı önlemek ve sağkalımı uzatmak amacıyla kullanılmaktadır. Cerrahi sonrası nükste hangi faktörlerin önemli olduğu tam olarak anlaşılamamıştır. Çalışmamızda mide kanseri hastalarında neoadjuvan kemoterapi tedavi süresi, tümör histopatolojisi ve biyokimyasal değerlerin cerrahi sonrası nüks üzerindeki etkisi araştırılmıştır. Yöntem: Çalışmamıza lokal ileri evre mide kanseri tanısı olan, neoadjuvan kemoterapi sonrası cerrahi uygulanan 61 hasta dahil edildi. Hastaların neoadjuvan ile tedavi süresi, cerrahide çıkarılan patolojik lenf nodu sayısı, preoperatif albümin seviyesi, postoperatif karsiyoembriyonik antijen (CEA) değerleri karşılaştırılıp, nüks durumuna göre değerlendirildi. Bulgular: Hastalarımızın yaş ortalaması 58.70±10.58’dir. Cerrahi sonrası nüks gelişen hastalarda cerrahide çıkarılan patolojik lenf nodu sayısının ve postoperatif CEA değerinin istatistiksel olarak önemli düzeyde daha fazla olduğu (sırasıyla p <0.001, p=0.005), preoperatif albümin seviyesinin yüksekliğinin nüksü azalttığı (HR=0.016) bulunmuştur. Sonuç: Çalışmamızda neoadjuvan tedavi alan mide kanseri hastalarında, preoperatif albümin seviyesi ve postoperatif CEA değerinin cerrahi sonrası nüks gelişimi ile ilişkili olduğu gösterilmiştir.

Anahtar Kelimeler:

Mide kanseri, neoadjuvan tedavi, cerrahi sonrası nüks

Factors predicting recurrence ın operated locally advanced gastric cancer patients treated with neoadjuvant therapy

Aim: Neoadjuvant chemotherapy is used to increase tumor resection rates, prevent metastasis and prolong survival. It is not fully understood which factors are important in recurrence after surgery. In our study, the effects of neoadjuvant chemotherapy treatment duration, tumor histopathology, and biochemical values on postoperative recurrence in gastric cancer patients were investigated. Method: Our study included 61 patients who were diagnosed with locally advanced gastric cancer and underwent surgery after neoadjuvant chemotherapy. The duration of treatment with neoadjuvant, the number of pathological lymph nodes removed during surgery, preoperative albumin level, and postoperative carcinoembryonic antigen (CEA) values were compared and evaluated according to the recurrence status. Results: The mean age of our patients was 58.70±10.58 years. In patients who developed recurrence after surgery, the number of pathological lymph nodes removed during surgery and the postoperative CEA value was found to be statistically significantly higher (p <0.001, p=0.005, respectively), and high preoperative albumin levels reduced recurrence (HR=0.016). Conclusion: In our study, it was shown that preoperative albumin level and postoperative CEA value were associated with the development of recurrence after surgery in gastric cancer patients receiving neoadjuvant therapy.

Keywords:

Gastric cancer, neoadjuvant chemotherapy, postoperative recurrence,

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Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660.
Fitzmaurice C, Abate D, Abbasi N, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2019;5(12):1749-1768. doi: 10.1001/jamaoncol.2019.2996.
Balakrishnan M, George R, Sharma A, Graham DY. Changing Trends in Stomach Cancer Throughout the World. Curr Gastroenterol Rep. 2017;19(8):36. doi: 10.1007/s11894-017-0575-8.
Choi IJ, Kim CG, Lee JY, et al. Family History of Gastric Cancer and Helicobacter pylori Treatment. N Engl J Med. 2020;382(5):427-436. doi: 10.1056/NEJMoa1909666.
Serra O, Galán M, Ginesta MM, et al. Comparison and applicability of molecular classifications for gastric cancer. Cancer Treat Rev. 2019;77:29-34. doi: 10.1016/j.ctrv.2019.05.005.
Ma J, Shen H, Kapesa L, Zeng S. Lauren classification and individualized chemotherapy in gastric cancer. Oncol Lett. 2016;11(5):2959-2964. doi: 10.3892/ol.2016.4337.
Goetze OT, Al-Batran S-E, Chevallay M, Mönig SP. Multimodal treatment in locally advanced gastric cancer. Updates in Surgery. 2018;70(2):173-179. doi: 10.1007/s13304-018-0539-z.
Tokunaga M, Sato Y, Nakagawa M, et al. Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives. Surgery Today. 2020;50(1):30-37. doi: 10.1007/s00595-019-01896-5.
Lumish MA, Ku GY. Approach to Resectable Gastric Cancer: Evolving Paradigm of Neoadjuvant and Adjuvant Treatment. Curr Treat Options Oncol. 2022;23(7):1044-1058. doi: 10.1007/s11864-021-00917-1.
Sun J, Wang X, Zhang Z, et al. The Sensitivity Prediction of Neoadjuvant Chemotherapy for Gastric Cancer. Front Oncol. 2021;11:641304. doi: 10.3389/fonc.2021.641304.
Xu AM, Huang L, Liu W, et al. Neoadjuvant chemotherapy followed by surgery versus surgery alone for gastric carcinoma: systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(1):e86941. doi: 10.1371/journal.pone.0086941.
Ai S, Sun F, Liu Z, et al. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ J Surg. 2019;89(7-8):E297-e301. doi: 10.1111/ans.15363.
Wang YH, Kang JK, Zhi YF, et al. The pretreatment thrombocytosis as one of prognostic factors for gastric cancer: A systematic review and meta-analysis. Int J Surg. 2018;53:304-311. doi: 10.1016/j.ijsu.2018.03.084.
Yu JH, Wang ZZ, Fan YC, et al. Comparison of neoadjuvant chemotherapy followed by surgery vs. surgery alone for locally advanced gastric cancer: a meta-analysis. Chin Med J (Engl). 2021;134(14):1669-1680. doi: 10.1097/cm9.0000000000001603.
Inagaki K, Kanda M, Nakanishi K, et al. Accurate Prediction of Prognosis After Radical Resection of Gastric Cancer by the Modified Systemic Inflammation Score; a Multicenter Dataset Analysis. World Journal of Surgery. 2021;45(8):2513-2520. doi: 10.1007/s00268-021-06138-9.
Wu L, Liang Y, Zhang C, et al. Prognostic significance of lymphovascular infiltration in overall survival of gastric cancer patients after surgery with curative intent. Chin J Cancer Res. 2019;31(5):785-796. doi: 10.21147/j.issn.1000-9604.2019.05.08.
Aoyama T, Komori K, Tamagawa A, et al. Clinical Influence of the Lymph Node Ratio on Lymph Node Metastasis-positive Gastric Cancer Patients Who Receive Curative Treatment. In Vivo. 2022;36(2):994-1000. doi: 10.21873/invivo.12792.
Shannon AB, Straker RJ, Keele L, et al. Lymph Node Evaluation after Neoadjuvant Chemotherapy for Patients with Gastric Cancer. Annals of Surgical Oncology. 2022;29(2):1242-1253. doi: 10.1245/s10434-021-10803-7.
Uda H, Kanda M, Tanaka C, et al. Perioperative Serum Carcinoembryonic Antigen Levels Predict Recurrence and Survival of Patients with Pathological T2-4 Gastric Cancer Treated with Curative Gastrectomy. Dig Surg. 2018;35(1):55-63. doi: 10.1159/000471931.
Zhao J, Wang G, Jiang ZW, et al. Patients Administered Neoadjuvant Chemotherapy Could be Enrolled into an Enhanced Recovery after Surgery Program for Locally Advanced Gastric Cancer. Chin Med J (Engl). 2018;131(4):413-419. doi: 10.4103/0366-6999.225047.
Yu H, Xu L, Yin S, et al. Risk Factors and Prognostic Impact of Postoperative Complications in Patients with Advanced Gastric Cancer Receiving Neoadjuvant Chemotherapy. Curr Oncol. 2022;29(9):6496-6507. doi: 10.3390/curroncol29090511.
Migita K, Matsumoto S, Wakatsuki K, et al. A decrease in the prognostic nutritional index is associated with a worse long-term outcome in gastric cancer patients undergoing neoadjuvant chemotherapy. Surgery Today. 2017;47(8):1018-1026. doi: 10.1007/s00595-017-1469-y.
Toiyama Y, Yasuda H, Ohi M, et al. Clinical impact of preoperative albumin to globulin ratio in gastric cancer patients with curative intent. Am J Surg. 2017;213(1):120-126. doi: 10.1016/j.amjsurg.2016.05.012.
Joliat GR, Schoor A, Schäfer M, et al. Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review. Perioper Med (Lond). 2022;11(1):7. doi: 10.1186/s13741-022-00238-3.