Cem MİRİLİ, Semra PAYDAS, Mahmut BUYUKSİMSEK, Mert TOHUMCUOGLU, Abdullah EVREN YETİSİR, Ali OGUL

Mesna-doxorubisin-ifosfamid-dakarbazin (MAID) ile tedavi edilen Yumuşak doku sarkom hastalarımızın uzun dönem takip sonuçları: Tek merkez deneyimi

Amaç Yumuşak doku sarkomları (STS) erişkin kanserlerin %1 ini oluşturan agresif kanserlerdendir. Temel tedavisi cerrahi rezeksiyon olmakla beraber kemoterapi ve radyoterapide uygun hastalarda kullanılmaktadır. Doxorubisin temelli tedaviler en sık kullanılan kemoterapi rejimleridir ancak bu rejimlerle ilgili gerçek hayat verisi ülkemizde çok azdır. Bizde bu sebeple mesna-doxorubisin-ifosfamid-dakarbazin içeren MAID rejimi başlangıç tedavisi olarak alan STS olgularımızın yaşam sürelerini tespit etmek ve prognostik olabilecek klinik ve demografik özellikleri ortaya çıkarmak istedik. Materyal ve Metod Çukurova Üniversitesi Tıp Fakültesi Tıbbi Onkoloji Anabilim Dalı'nda 2007-2016 yılları arasında Yumuşak doku sarkomu tanısı alan ve başlangıç tedavisi olarak MAID rejimi uygulanan 45 hasta retrospektif olarak çalışmaya dahil edildi. Genel sağkalım (OS) ve progresyonsuz sağkalım (PFS) ile klinikopatolojik parametreler arasındaki ilişkiler Kaplan-Meier eğrileri kullanılarak analiz edildi ve log-rank testi ile karşılaştırıldı. Tek değişkenli ve çok değişkenli analiz PFS ve OS için prognostik faktörleri tespit etmek amacıyla kullanılmıştır. Bulgular Hastalarımızın median yaşı 49 olup en sık görülen alttip undiferansiye pleomorfik karsinom (%37,8) ardından liposarkom (%17,8), leiomyosarkom (%13,3) gelmektedir ve olguların %62,2 si extremite lokalizasyonunda saptanmıştır. Evrelerine göre %15,6 evre 1-2, %53,3 ü evre 3 ve %31,1 i evre 4 olarak ayrılmışlardı. Hastaların median PFS ve OS 17 ay ve 39 ay olup 5 yıllık PFS ve OS oranları %14 ve %32,5 dur. Yaş, cinisyet ve grade in prognostik önemi saptanmamış olup univariate analizlere göre mitoz, nekroz, AJCC TNM evresi ve cerrahi hem PFS hem de OS için prognostiktir. Bununla beraber multivariate analizlere göre sadece AJCC TNM evresi hem PFS hem de OS için bağımsız prognostik faktördür. Sonuç Başlangıç tedavisi olarak MAID kemoterapisi alan olgularda PFS ve OS için tek bağımsız prognostik faktör AJCC TNM evredir.

Anahtar Kelimeler:

Yumuşak doku sarkomu, prognostik faktörler, , doxorubisin

Long-term Outcome of Soft Tissue Sarcomas Treated with Mesna-Doxorubicin-Ifosfamid-Dacarbazine regimen (MAID): A Retrospective Study from a Single Institution

Objective Soft tissue sarcomas (STSs) account 1% of adult cancers. Essential treatment is surgery but chemotherapy and/or radiotherapy are frequently used due to aggressive behaviour or incomplete surgery. Doxorubicin-based regimens are the most frequently used chemotherapy combinations but real life data with these agents are relatively limited in our country. Here we wanted to present clinico-demographic and prognostic features of STS sarcoma cases treated by MAID regimen containing mesna-doxorubicin-ifosfamide-dacarbazin. Material and MethodForty five cases with STS treated with MAID regimen as initial therapy and followed between 2007-2016 in Cukurova University Medical Faculty Department of Medical Oncology were analyzed retrospectively. Associations between clinical and histopathological parameters with overall survival (OS) and progression free survival (PFS) were analyzed using Kaplan- Meier curves and compared by the log-rank test. Univariate and multivariate analyses were used to assess their prognostic values for PFS and OS.Results The median age of our patients was 49 and the most common subtypes were undifferentiated pleomorphic carcinoma (37.8%) followed by liposarcoma (17.8%), leiomyosarcoma (13.3%) and 62.2% of the cases were found in the extremity localization. According to their AJCC TNM stages, 15.6% were stage 1-2, 53.3% were stage 3 and 31.1% were stage 4. The median PFS and OS were 17 months and 39 months, and the 5-year PFS and OS rates were 14% and 32.5%. Prognostic significance of age, sex, and grade was not determined, but univariate analyzes indicated that mitosis, necrosis, AJCC TNM stage and surgery were prognostic for both PFS and OS. However, according to multivariate analyzes, only the AJCC TNM stage is an independent prognostic factor for both PFS and OS.Conclusion AJCC TNM is the only independent prognostic factor for both PFS and OS in patients with STS receiving MAID chemotherapy as initial therapy

Keywords:

Soft tissue sarcoma, prognosis, , doxorubicine,

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