Didem İKİZ, Esra KORKMAZ KIRAKLI, Senem DEMİRCİ, Aras ARİF, Zeynep ÖZSARAN

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Radikal Radyokemoterapi/Radyoterapi Uygulanan Serviks Karsinomu Olgularında Açlık Kan Şekeri Düzeylerinin Tedavi Sonuçlarına Etkisi

Başlık: Radikal Radyokemoterapi/Radyoterapi Uygulanan Serviks Karsinomu Olgularında Açlık Kan Şekeri Düzeylerinin Tedavi Sonuçlarına EtkisiTürkçe ÖzetAmaç: Serviks kanseri dünya genelinde kadınlarda en sık görülen dördüncü kanserdir. Kanser olgularında yüksek kan şekeri düzeylerinin düşük sağkalımla ilişkisini gösteren birçok klinik çalışma yayınlanmıştır. Serviks kanserinde de artmış açlık kan şekeri (AKŞ) düzeyleri artmış mortalite ile ilişkili bulunmuştur. Bu çalışmada radikal radyokemoterapi/radyoterapi uygulanan serviks karsinomu olgularında AKŞ düzeylerinin yineleme ve genel sağkalıma (GS) etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: 2005-2013 arasında evreIB-IVB serviks karsinomu tanısıyla eşzamanlı radyokemoterapi/radyoterapi uygulanan 150 olgunun verileri geriye dönük olarak analiz edilmiştir. AKŞ değerleri tedavi öncesi, tedavi sırası ve tedavi sonrası olmak üzere 3 ayrı dönemde incelenmiştir <100mg/dl normal-AKŞ, ≥100 ve ˂126mg/dl pre-dyiabetik AKŞ, ≥126mg/dl diyabetik-AKŞ olarak kabul edilmiştir. Sonuçlar: Ortanca takip süresi 64 aydı. 5 yıllık GS %57, hastalıksız sağkalım %46’idi. Üç tedavi dönemindeki AKŞ değerlerinin lokal-bölgesel yineleme, uzak yineleme ve GS tahmin için ROC analizi yapıldığında, 100 mg/dl düzeyinin; uzak yineleme için tedavi öncesi dönemde duyarlılığının % 89, özgüllüğünün % 48 (AUC: 0.69, CI: 0.58-0.80) p:0.003, yine uzak yineleme için tedavi sonrası dönemde duyarlılığının % 86, özgüllüğünün % 43 (AUC: 0.69, CI: 0.57-0.80) p:0.004 ve GS için tedavi sonrası dönemde duyarlılığının % 70, özgüllüğünün % 44 (AUC: 0.61, CI: 0.50-0.72) p:0.039 olduğu tespit edilmiştir. Tedavi sonrası dönemde uzak yineleyen ve ex olan olguların ortanca AKŞ düzeyleri uzak yinelemeyen ve yaşayan olgulara göre anlamlı olarak daha yüksek bulunmuştur.    Sonuç: Tedavi öncesi ve sonrası dönemde 100 mg/dl üzeri AKŞ düzeyleri tedavi sonuçlarını kötüleştirebilir. Uzak yineleyen ve ex olan olgularda tedavi sonrası dönemde AKŞ seviyeleri yinelemeyen ve sağ olgulara göre daha yüksektir. İngilizce Özet (Abstract)Aim: Cervical cancer is the fourth common cancer in women worldwide. The importance of glucose metabolism in cancer developement and progression has been focus of interest in recent years. Increased blood glucose level has been proven to be related with increased mortality in cervical cancer. The aim of this study, is to evaluate the relation between fasting blood glucose levels(FBG) and treatment outcomes in cervical cancer treated with radical radiochemotherapy/radiotherapy. Material and Methods: The medical records of 150 patients with stage IB-IVB cervical cancer treated with radical radiotherapy/radiotherapy between 2005-2013 were reviewed retrospectively. FBG levels were recorded in pre-treatment, treatment and post-treatment periods and were categorised as normal if FBG is <100mg/dl, as pre-diabetic if FBG is ≥100mg/dl and ˂126mg/dl, as diabetic if FBG is ≥126 mg/dl. Results: Median follow-up was 64 months. 5y OS was 57%, 5y DFS was 46%. ROC analyis for FBG was carried out for 3 different treatment periods to predict DM and OS; for 100mg/dl in pre-treatment period was found to have 89% sensitivity,48% specifity (AUC:0.69, CI:0.58-0.80) p:0.003 for  DM, 100mg/dl in post-treatment period was found to have 86% sensitivity,43% specifity (AUC:0.69,CI:0.57-0.80) p:0.004 for DM,  100mg/dl in post-treatment period was found to have 70% sensitivity,44% specifity (AUC:0.61, CI:0.50-0.72) p:0.039  for OS. Patients with DM and died patients had significantly higher median FBG level in post-treatment period compared to non-relapsing and alive patients, Conclusion: 100 mg/dl FBG levels  in pre and post-treatment period might worsen treatment outcomes. The patients with DM and shorter survival had higher FBG levels in post-treatment period.
Anahtar Kelimeler:

serviks karsinomu; hiperglisemi; tedavi sonuçları

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Türk Jinekolojik Onkoloji Dergisi-Cover
  • ISSN: 2148-5372
  • Başlangıç: 2014
  • Yayıncı: Türk Jinekolojik Onkoloji Derneği
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