Tezcan AKIN, Serhat OCAKLI, Gizem GÜNEŞ, İbrahim DOĞAN, Merve AKIN, Erdinç ÇETİNKAYA, Hüseyin BERKEM, Sadettin ER, Mesut TEZ

MODİFİYE SİSTEMİK İNFLAMASYON SKORU YÜKSEK DERECE DİSPLAZİLİ KOLOREKTAL POLİPLERDE İNVAZİV KARSİNOM VARLIĞINI ÖNGÖRMEDE KULLANILABİLİR

Amaç Son yıllarda sistemik inflamasyon skor (SIS) ve modifiye sistemik inflamasyon skor (mSIS) gibi skorların kolorektal kanserlerde prognostik ve prediktif değerleri araştırılmıştır. Bu çalışmada, basit labaratuvar testleri ile hesaplanan modifiye sistemik inflamatuar skorun (mSIS) high grade displazili (HGD) kolon poliplerinde invaziv karsinom varlığını öngörmedeki etkinliği araştırıldı. Gereç ve Yöntem Ocak 2019 -Ekim 2021 tarihleri arasında preoperatif HGD tanısıyla opere edilen 44 kolorektal polipli hastanın postoperatif verileri retrospektif olarak incelendi. Hastalar postoperatif histopatolojik inceleme sonuçlarına göre HGD, Tis veya adenomatöz polip ve invaziv karsinom olarak iki gruba ayrıldı. mSIS hesaplaması; mSIS 0 [albümin (ALB) ≥ 4.0 g/dL ve lenfosit/ monosit oranı (LMR) ≥ 3.4], mSIS 1 (ALB <4.0 g / dL veya LMR <3.4) ve mSIS 2 (ALB <4.0 g / dL ve LMR <3.4) şeklinde yapıldı. Bulgular Postoperatif patoloji sonuçları HGD, Tis veya adenomatöz polip olan 17 hastanın 14’ünde (%82,4) mSIS skoru 0 ve 3’ünde ise (%17,6) mSIS skoru 1 veya 2 olarak saptandı. Patoloji sonuçları invaziv karsinom olan 27 hastanın 7’sinin (%25,9) mSIS skoru 0 ve 20’sinin (%75,1) mSIS skoru 1 veya 2 olarak bulundu. Hastaların mSIS skorları ile patoloji sonuçları invaziv karsinom olan hastalar arasında anlamlı ilişki bulundu (p<0,05). Sonuç HGD’li hastalarda preoperatif dönemde mSIS skoru hesaplanarak mSIS 1 veya 2 olan hastalarda postoperatif patoloji sonuçlarının invaziv karsinom olabileceği öngörülebilir ve tedavi planını belirlemeye katkısı olabileceği sonucuna varıldı.

Anahtar Kelimeler:

kolorektal konser, Modifiye sistemik inflamtuar skor, inflamatuar belirteçler, high-grade displazi

THE MODIFIED SYSTEMIC INFLAMMATION SCORE CAN BE USED TO PREDICT THE PRESENCE OF INVASIVE CARCINOMA IN COLORECTAL POLYPS WITH HIGH-GRADE DYSPLASIA

Objective In recent years, the prognostic and predictive values of scoring systems such as systemic inflammation score (SIS) and modified systemic inflammation score (mSIS) have been investigated in colorectal cancers. To investigate the efficacy of the modified systemic inflammatory score (mSIS) calculated by simple laboratory tests in predicting the presence of invasive carcinoma in colon polyps with high-grade dysplasia (HGD). Materials and Methods The postoperative data of 44 patients with colorectal polyps who underwent surgery with the diagnosis of preoperative HGD between January 2019 and October 2021 were retrospectively analyzed. According to the results of the postoperative histopathological examination, the patients were divided into two groups as HGD/intramucosal carsinom (Tis)/adenomatous polyp and invasive carcinoma. mSIS calculation was made as follows: mSIS 0 [albumin (ALB)≥4.0 g/dL and lymphocyte/ monocyte ratio (LMR)≥3.4], mSIS 1 (ALB<4.0 g/dL or LMR<3.4) and mSIS 2 (ALB<4.0 g/dL and LMR< 3.4). Results According to the postoperative pathology results, the mSIS score was 0 in 14 (82.4%) of 17 patients with Tis/adenomatous polyps, and 1 or 2 in three patients in this group (17.6%). Among the 27 patients with invasive carcinoma, mSIS was 0 in seven (25.9%) and 1 or 2 in 20 (75.1%). A significant correlation was found between mSIS and the pathology results of the patients with invasive carcinoma (p<0.05). Conclusion In patients with HGD, by calculating mSIS in the preoperative period, the postoperative pathology results in patients with mSIS 1 or 2 can be predicted to be invasive carcinoma, which can contribute to the determination of the appropriate treatment plan.

Keywords:

High-grade dysplasia, Colorectal Carcinoma, Inflammatory markers, Modified Systemic Inflammation Score,

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1. F. Bray, J. Ferlay, I. Soerjomataram, R.L. Siegel, L.A. Torre, A. Jemal, Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries, CA: a cancer journal for clinicians, 68 (2018) 394-424.
2. L.H. Nguyen, A. Goel, D.C. Chung, Pathways of colorectal carcinogenesis, Gastroenterology, 158 (2020) 291-302.
3. E. Gorgun, C. Benlice, J.M. Church, Does cancer risk in colonic polyps unsuitable for polypectomy support the need for advanced endoscopic resections? Journal of the American College of Surgeons, 223 (2016) 478-484.
4. O. Engin, Colon Polyps and Colorectal Cancer, Springer2020.
5. J.H. Jang, E. Balik, D. Kirchoff, W. Tromp, A. Kumar, M. Grieco, D.L. Feingold, V. Cekic, L. Njoh, R.L. Whelan, Oncologic colorectal resection, not advanced endoscopic polypectomy, is the best treatment for large dysplastic adenomas, Journal of Gastrointestinal Surgery, 16 (2012) 165-172.
6. S. Jones, W.-d. Chen, G. Parmigiani, F. Diehl, N. Beerenwinkel, T. Antal, A. Traulsen, M.A. Nowak, C. Siegel, V.E. Velculescu, Comparative lesion sequencing provides insights into tumor evolution, Proceedings of the National Academy of Sciences, 105 (2008) 4283-4288.
7. P.J. Pickhardt, B.D. Pooler, D.H. Kim, C. Hassan, K.A. Matkowskyj, R.B. Halberg, The natural history of colorectal polyps: overview of predictive static and dynamic features, Gastroenterology Clinics, 47 (2018) 515-536.
8. J.S. Levine, D.J. Ahnen, Adenomatous polyps of the colon, New England Journal of Medicine, 355 (2006) 2551-2557.
9. M. Climent, É.J. Ryan, Á. Stakelum, Y.L. Khaw, B. Creavin, A. Lloyd, D. Alhassan, H.M. Mohan, R. Kennelly, K. Sheahan, Systemic inflammatory response predicts oncological outcomes in patients undergoing elective surgery for mismatch repair- deficient colorectal cancer, International journal of colorectal disease, 34 (2019) 1069-1078.
10. Y. Suzuki, K. Okabayashi, H. Hasegawa, M. Tsuruta, K. Shigeta, T. Kondo, Y. Kitagawa, Comparison of preoperative inflammation- based prognostic scores in patients with colorectal cancer, Annals of surgery, 267 (2018) 527-531.
11. R.D. Dolan, S.T. McSorley, J.H. Park, D.G. Watt, C.S. Roxburgh, P.G. Horgan, D.C. McMillan, The prognostic value of systemic inflammation in patients undergoing surgery for colon cancer: comparison of composite ratios and cumulative scores, British journal of cancer, 119 (2018) 40-51.
12. F. Wang, W. He, C. Jiang, G. Guo, B. Ke, Q. Dai, J. Long, L. Xia, Prognostic value of inflammation-based scores in patients receiving radical resection for colorectal cancer, BMC cancer, 18 (2018) 1-10.
13. H. Ataş, B. Korukluoğlu, B.A. Özdemir, N. Yakşi, B. Saylam, M. Tez, Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules, The American Journal of Surgery, 221 (2021) 117-121.
14. J.-X. Lin, J.-P. Lin, J.-W. Xie, J.-b. Wang, J. Lu, Q.-Y. Chen, L.-l. Cao, M. Lin, R. Tu, C.-H. Zheng, Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer, Gastric Cancer, 22 (2019) 403-412.
15. H. AtaŞ, B. KorukluoĞlu, B. ÇomÇali, N. YakŞİ, B. Saylam, M. Tez, Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?, Turkish Journal of Medical Sciences, (2021).
16. T. Suzuki, Y. Ishibashi, H. Tsujimoto, S. Nomura, K. Kouzu, Y. Itazaki, T. Sugihara, M. Harada, N. Ito, H. Sugasawa, A Novel Systemic Inflammatory Score Combined With Immunoinflammatory Markers Accurately Reflects Prognosis in Patients With Esophageal Cancer, in vivo, 34 (2020) 3705-3711.
17. M. Shibutani, K. Maeda, H. Nagahara, T. Fukuoka, S. Matsutani, K. Kimura, R. Amano, K. Hirakawa, M. Ohira, The prognostic value of the systemic inflammatory score in patients with unresectable metastatic colorectal cancer, Oncology letters, 16 (2018) 666-672.
18. S. Rüth, J. Spatz, M. Anthuber, Is There an Indication for Surgical Resection in Colorectal Adenoma?, Visceral Medicine, 30 (2014) 46-51.
19. R. Rodrigues, S. Geyl, J. Albouys, C. De Carvalho, M. Crespi, T. Tabouret, A. Taibi, S. Durand-Fontanier, R. Legros, M. Dahan, Effect of implementing a regional referral network on surgical referral rate of benign polyps found during a colorectal cancer screening program: A population-based study, Clinics and Research in Hepatology and Gastroenterology, 45 (2021) 101488.
20. A. Emmanuel, S. Gulati, M. Burt, B.H. Hayee, A. Haji, Colorectal endoscopic submucosal dissection: patient selection and special considerations, Clinical and experimental gastroenterology, 10 (2017) 121.
21. S. Tanaka, H. Kashida, Y. Saito, N. Yahagi, H. Yamano, S. Saito, T. Hisabe, T. Yao, M. Watanabe, M. Yoshida, JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection, Digestive Endoscopy, 27 (2015) 417-434.
22. J.M. McDonald, R. Moonka, R.H. Bell Jr, Pathologic risk factors of occult malignancy in endoscopically unresectable colonic adenomas, The American journal of surgery, 177 (1999) 384- 387.
23. R. Loungnarath, M.G. Mutch, E.H. Birnbaum, T.E. Read, J.W. Fleshman, Laparoscopic colectomy using cancer principles is appropriate for colonoscopically unresectable adenomas of the colon, Diseases of the colon & rectum, 53 (2010) 1017-1022.
24. L. Bujanda, A. Cosme, I. Gil, J.I. Arenas-Mirave, Malignant colorectal polyps, World journal of gastroenterology: WJG, 16 (2010) 3103.
25. T. Yao, S. Shiono, Differences in the pathological diagnosis of colorectal neoplasia between the East and the West: Present status and future perspectives from Japan, Digestive Endoscopy, 28 (2016) 306-311.
26. H. Ikematsu, Y. Yoda, T. Matsuda, Y. Yamaguchi, K. Hotta, N. Kobayashi, T. Fujii, Y. Oono, T. Sakamoto, T. Nakajima, Longterm outcomes after resection for submucosal invasive colorectal cancers, Gastroenterology, 144 (2013) 551-559.