Evre III rektal kanserlerde kötü sağkalım ile ilişkili yeni prognostik belirteçler: İnvasiv büyüme paterni ve Tümör nekrozu

Amaç: Rektal kanserler (RK) batı dünyasında en sık görülen kanserlerden biridir. RK için en önemli prediktif gösterge TNM sistemidir. Bununla birlikte, aynı tümör evresi ile karakterize edilen hastalar sıklıkla belirgin farklı sağ kalımlara sahiptir. Bu araştırmada, stage III RK’larda İnvasiv büyüme paterni (İBP) ve Tümör nekrozu (TN)’nun hayatta kalmaya etkisini analiz ettik.Gereç ve Yöntemler: 1999-2012 yılları arasında Kırıkkale Üniversite’sinde stage III RK nedeniyle opere olan yüzkırk beş hasta bu çalışmaya dahil edildi. Bu parametreler hematoksilen ve eozin boyalı kesitlerde skorlandı. Sonuçlar ve klinikopatolojik özellikler arasındaki ilişki analiz edildi.Bulgular: Bu parametreler, büyük boyutlu tümör (İBP: p<0.001; TN: p=0.033), ileri PT (İBP: p=0.016; TN: p=0.047), angiolymphatic invazyon (İBP: p = 0.025), lenf nodu metastazı sayısı (İBP: p<0.001; TN: p=0.001), ileri evre (İBP: p<0.001; TN: p=0.018) ve ileri grade (İBP: p < 0.001) bulgusu gösteren RK’larda anlamlı olarak artırıyordu. Tek değişkenli analizde, bu iki parametreye sahip hastalar 5 yıllık kötü sağkalıma sahipti ([İBP= RFS: 50%, p=0.001; OS=55%, p=0.003], [TN= RFS: 53%, p=0.005; OS: 58%, p=0.017]). Çok değişkenli analizler, bu iki parametrenin RFS (İBP=Hazard ratio [HR]: 1.58 [1.05-2.66], p=0.005; TN=1.44 [1.07–2.34], p=0.013) ve OS (İBP=HR: 1.55 [1.11–3.18], p=0.008; TN= 1.38 [1.09–2.28], p=0.024) için bağımsız bir kötü hayatta kalma parametresi olduğunu doğruladı. Ayrıca, IGP'nin TN'den daha yararlı olduğu bulundu. Sonuç: Verilerimiz İBP ve TN’nin RK için değerli prognostik bilgiler sağladığını ve mevcut risk sınıflamasına bu parametrelerin eklenmesinin daha iyi hasta seçimine katkıda bulunabileceğini göstermektedir.

Anahtar Kelimeler:

İnvasive büyüme paterni, tümör nekrozu, rektal kanser, prognostik belirteçler

Novel prognostic markers associated with poor survival in stage III rectal cancers: Invasive growth pattern and Tumor necrosis

Aim: Rectal carcinomas (RC) are one of the most common cancers in the western world. TNM system is the most significant predictive indicator in these tumors but patients characterized by the same stage often have prominent distinct survival. In this research, we analyzed the survival effect of Invasive growth pattern (IGP) and Tumor necrosis (TN) in stage III RC.Material and Methods: A hundred forty-five patients operated for stage III RC during 1999-2012 at Kırıkkale University were included in this research. These parameters were scored on hematoxylin and eosin stained sections. The relationship between the results and the clinicopathological characteristics was analyzed.Results: These parameters were significantly upregulated in RCs which classified as higher tumor size (IGP: p<0.001; TN: p=0.033), higher pT (IGP: p=0.016; TN: p=0.047), angiolymphatic invasion (IGP: p=0.025), high number metastatic lymph nodes (IGP: p<0.001; TN: p=0.001), advanced stage (IGP: p<0.001; TN: p=0.018), and advanced grade (IGP: p<0.001). In univariate analysis, patients with these two parameters had worse 5-year survival ([IGP= RFS: 50%, p=0.001; OS=55%, p=0.003], [TN= RFS: 53%, p=0.005; OS: 58%, p=0.017]). Multivariate analyzes confirmed that these two parameters are an independent worse survival parameter for RFS (IGP=Hazard ratio [HR]: 1.58 [1.05-2.66], p=0.005; TN=1.44 [1.07–2.34], p=0.013) and OS (IGP=HR: 1.55 [1.11–3.18], p=0.008; TN= 1.38 [1.09–2.28], p=0.024). In addition, IGP was found to be more successful than TN. Conclusion: Our data suggest that IGP and TN provide valuable prognostic information for RC, and adding these parameters to the current risk classification may contribute to better patient selection.

Keywords:

Invasive growth pattern, Tumor necrosis, rectal cancer, prognostic markers,

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