Ahmet KÜÇÜK, Düriye ÖZTÜRK, Hüseyin PÜLAT, Recep ÇAĞLAR, Şükran ESKİCİ ÖZTEP, Eda Bengi YILMAZ, Erkan TOPKAN

Radikal gastrektomi sonrası eş zamanlı kemoradyoterapi uygulanan lokal ileri evre mide kanserlerinde mide kanseri prognostik indeksinin önemi

Amaç: Radikal gastrektomi sonrası eş zamanlı kemoradyoterapi ile tedavi edilen lokal ileri evre mide kanseri hastalarında albümin ve metastatik lenf nodu sayısının bir kombinasyonu olan yeni mide kanseri prognostik indeksinin önemi araştırılmıştır. Yöntem: Bu retrospektif çalışmamıza Ocak 2014 ile Aralık 2019 tarihleri arasındaki hastalar dahil edilmiştir. Albümin için eşik değer 3.5 g/dL kabul edilirken, metastatik lenf nodu sayısı için ideal eşik değerini tanımlamak amacıyla ‘’receiver operating characteristic’’ eğrisi analizi kullanılmıştır. Bulgular: Çalışmamıza toplam 137 hasta dahil edilmiştir. Albümin 3.5 g/dL (<3.5’e karşılık ≥3.5 g/dL) ve metastatik lenf nodu sayısı için ise eşik değer 5’e göre (<5’e karşılık ≥5) dört olası grup oluşturulmuştur. Grup-1: Albümin ≥3.5 g/dL ve metastatik lenf nodu sayısı <5 Grup-2: Albümin ≥3.5 g/dL ve metastatik lenf nodu sayısı ≥5, Grup- 3: Albümin <3.5 g/dL ve metastatik lenf nodu sayısı <5 ve Grup-4: Albümin <3.5 g/dL ve metastatik lenf nodu sayısı ≥5. Sağ kalım analizlerinde Grup 2 ve Grup 3 arasında anlamlı bir fark bulunmadığı için bu iki grup birleştirilerek mide kanseri prognostik indeksi-2 oluşturulmuştur. Kaplan-Meier eğrilerinden mide kanseri prognostik indeksi-1 ve mide kanseri prognostik indeksi-3 gruplarının sırasıyla progresyonsuz (66.0 aya karşı 16.4 ay; p<0.001) ve genel sağ kalım (66.0 aya karşı 19.5 ay p<0.001) sonuçlarına sahip olduğu belirlenmiştir. Çok değişkenli analiz sonuçları yeni mide kanseri prognostik indeksinin genel (p<0.001) ve progresyonsuz sağ kalım (p=0.05) için bağımsız bir prognostik faktör olduğunu göstermiştir. Sonuç: Çalışmamızdan elde edilen sonuçlar mide kanseri prognostik indeksinin güçlü ve bağımsız bir belirteç olduğunu göstermiştir

Anahtar Kelimeler:

Eş zamanlı kemoradyoterapi, mide kanseri, sağ kalım sonuçları

The importance of the novel gastric cancer prognostic index in patients with locally advanced gastric cancer who underwent radical gastrectomy and chemoradiotherapy

Aim: The significance of the novel gastric cancer prognostic index, hich combines albumin and metastatic lymph node count, on the outcomes of patients with locally advanced gastric cancer who received radical gastrectomy and concurrent chemoradiotherapy, was investigated. Method: Patients who between January 2014 and December 2019 were included in this retrospective analysis. According to the literature, the ideal cutoff value for albumin was determined to be 3.5 g/dL. While, the optimal cutoff for metastatic lymph node count was determined using receiver operating characteristic curve analysis. Results: This retrospective study comprised a total of 137 locally advanced gastric cancer patients. The ideal albumin cutoff was chosen to be the classically referred 3.5 g/dL (<3.5 versus ≥3.5 g/dL), while the results of the receiver operating characteristic curve analysis revealed the ideal metastatic lymph node count cutoff as 5 (<5 versus ≥5). Hence, the study population was divided into four possible groups: Group-1: albumin ≥3.5 g/dL and metastatic lymph node count <5, Grup-2: albumin ≥3.5 g/dL and metastatic lymph node count ≥5, Grup- 3: albumin <3.5 g/dL and metastatic lymph node count <5, and Grup-4: albumin <3.5 g/dL and metastatic lymph node count ≥5. Since of groups 2 and 3 were statistically indistinguishable, we merged them into a single group to create gastric cancer prognostic index-2. The Kaplan-Meier curves revealed that the gastric cancer prognostic index-1 and gastric cancer prognostic index-3 represented progression-free (66.0 versus 16.4 months; p<0.001) and overall survival (66.0 versus 19.5 months, p<0.001) respectively. The results of the multivariate analysis confirmed the gastric cancer prognostic index grouping's independent prognostic significance for overall (p<0.001) and progression-free survival (p=0.05) outcomes. Conclusion: The findings of this study gastric cancer prognostic index may be utilized as an independent and precise prognostic indicator.

Keywords:

Concurrent chemoradiotherapy, gastric cancer, survival results,

PDF

___

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108. doi:10.3322/caac.21262
De Manzoni G, Verlato G, Di Leo A, et al. Perigastric lymph node metastases in gastric cancer: Comparison of different staging systems. Gastric Cancer. 1999; 2: 201–205.
Chen CY, Wu CW, Lo SS, Hsieh MC, Lui WY, Shen KH. Peritoneal carcinomatosis and lymph node metastasis are prognostic indicators in patients with Borrmann type IV gastric carcinoma. Hepatogastroenterology. 2002; 49(45): 874-877
Takagane A, Terashima M, Abe K, et al. Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer. Gastric Cancer. 1999; 2: 122–128.
Coburn NG, Swallow CJ, Kiss A, Law C. Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer. 2006; 107(9): 2143-2151. doi:10.1002/cncr.22229
Kodera Y, Yamamura Y, Shimizu Y, et al. Lymph node status assessment for gastric carcinoma: Is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM Classification Tumor Node Metastasis. J Surg Oncol. 1998; 69 :15–20.
Aiko T, Sasako M, The new Japanese Classification of Gastric Carcinoma: Points to be revised, Gastric Cancer. 1998; 1 :25–30,
Omejc M, Juvan R, Jelenc F, Repse S. Lymph node metastases in gastric cancer: Correlation between new and old UICC TNM classification. Int Surg. 2001; 86:14–19.
Zhan YQ, Sun XW, Li W, et al. Multivariate prognostic analysis in gastric carcinoma patients after radical operation. Ai Zheng. 2005; 24: 596–599.
Adachi Y, Kamakura T, Mori M, Baba H, Maehara Y, Sugimachi K. Prognostic significance of the number of positive lymph nodes in gastric carcinoma. Br J Surg. 1994; 81:414–416.
Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002; 9: 775–784.
Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014; 38(2):196-204. doi:10.1177/0148607113502674
Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness, The Lancet Oncology, 2014;15(11): e493–e503.
Ouyang X, Dang Y, Zhang F, Huang Q. Low serum albumin correlates with poor survival in gastric cancer patients. Clinical Laboratory. 2018; 64(3): 239–245. doi: 10.7754/clin.lab.2017.170804.
Filliatre-Clement L, Broseus J, Muller M, et al. Serum albumin or body mass index: Which prognostic factor for survival in patients with acute myeloblastic leukaemia? Hemato. Oncology, 2019; 37: 80-84. https://doi.org/10.1002/hon.2543
Oh SE, Choi MG, Seo JM, et al. Prognostic significance of perioperative nutritional parameters in patients with gastric cancer. Clin Nutr. 2019; 38(2): 870-876. doi: 10.1016/j.clnu.2018.02.015
Liu J, Chen S, Geng Q, et al. Prognostic value of pretreatment albumin–globulin ratio in predicting long-term mortality in gastric cancer patients who underwent D2 resection. OncoTargets and Therapy. 2017; 10:215-2162. doi: 10.2147/ott.s99282.
Lien YC, Hsieh CC, Wu YC, et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. Journal of Gastrointestinal Surgery. 2004; 8(8): 1041–1048. doi: 10.1016/j.gassur.2004.09.033.
Saito H, Kono Y, Murakami Y, et al. Postoperative serum albumin is a potential prognostic factor for older patients with gastric cancer. Yonago Acta Medica. 2018; 61(1):72-78. doi: 10.33160/yam.2018.03.010.
McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: A decade of experience in patients with cancer. Cancer Treat Rev. 2013; 39(5): 534–540. doi: 10.1016/j.ctrv.2012.08.003
Kim DY, Seo KW, Joo JK, et al. Prognostic factors in patients with node-negative gastric carcinoma: A comparison with node-positive gastric carcinoma. World J Gastroenterol. 2006; 12(8): 1182-1186. doi:10.3748/wjg.v12.i8.1182
Hochwald SN, Kim S, Klimstra DS, Brennan MF, Karpeh MS. Analysis of 154 actual five-year survivors of gastric cancer. J Gastrointest Surg. 2000; 4:520–525.
Ichikura T, Tomimatsu S, Okusa Y, Uefuji K, Tamakuma S. Comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage based on their location in patients with gastric cancer. J Clin Oncol. 1993; 11: 1894–1900.
Gunji Y, Suzuki T, Hori S, et al. Prognostic significance of the number of metastatic lymph nodes in early gastric cancer. Dig Surg. 2003; 20(2): 148-153. doi:10.1159/000069392
Pan QX, Su ZJ, Zhang JH, Wang CR, Ke SY. A comparison of the prognostic value of preoperative inflammation-based scores and TNM stage in patients with gastric cancer. Onco Targets Ther. 2015; 8: 1375–85. doi: 10.2147/ott. S82437
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2019; 43:181–93. doi: 10.1002/jpen.1451
Kamphorst JJ, Nofal M, Commisso C, et al. Human pancreatic cancer tumors are nutrient poor and tumor cells actively scavenge extracellular protein. Cancer Res. 2015; 75:544–53. doi: 10.1158/ 0008-5472.Can-14-2211
Anraku M, Shintomo R, Taguchi K, et al. Amino acids of importance for the antioxidant activity of human serum albumin as revealed by recombinant mutants and genetic variants. Life Sci. 2015; 134: 36–41. doi: 10.1016/j.lfs.2015.05.010
Eckart A, Struja T, Kutz A, et al. Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: A prospective study. The American Journal of Medicine. 2020; 133(6): 713–722. https://doi.org/10.1016/j.amjmed.2019.10.031