Metastatik kolorektal kanserli hastalarda primer tümör lokalizasyonunun tedavi yanıtına ve sağkalıma etkisi: Retrospektif analiz
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Tarih
2018
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Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kolorektal karsinomlar dünyada erkeklerdeki en sık üçüncü kadınlardaki en sık ikinci kanserdir. Dünyada kanser ilişkili mortalitelerin %8’inden sorumludur. Kolorektal karsinomlarda tanı anındaki hastalık evresi en önemli prognostik faktördür ve bu kanserlerin yaklaşık %20’si tanı anında uzak organ metastazı ile başvurmaktadır. Evre dışındaki prognostik ve prediktif etkisi olan faktörler son dönemlerde yapılan çalışmaların odak noktası haline gelmiştir.
Bu çalışma ile hastanemiz medikal onkoloji kliniğine başvurmuş metastatik kolorektal karsinom tanılı hastalarda primer tümör lokalizasyonunun progresyonsuz sağkalım ve genel sağkalıma ve tedavi yanıtına etkisini değerlendirmek amaçlanmıştır.
Gereç ve Yöntem: 2010-2015 tarihleri arasında Ege Üniversitesi Hastanesi Medikal Onkoloji Bilim Dalı Polikliniğine başvurmuş metastatik kolorektal karsinom tanılı hastalar çalışmaya dahil edilmiştir. 1600 hastanın dosyaları retrospektif olarak taranmış, 488 hastaya ait verileri kaydedilmiş ve analizleri yapılmıştır.
Bulgular: Hastaların %38,9’u kadın %61,1’i erkekti. Yaş ortalaması 59,8 idi. Hastaların %32,4’ü primer tümör odağına yönelik operasyon geçirmişti. Primer tümör lokalizasyonlarına göre dağılımları incelendiğinde hastaların %13,5’inde sağ kolon tümörü, %86,5’inde sol kolon tümörü olduğu izlendi. %34,6 hastanın k-ras wild tip %26,2 hastanın k-ras mutant olduğu görüldü. 304 hastaya birinci seri tedavide hedefe yönelik ajan verilmişti, hastaların %54,7’si bevasizumab %5,3 ü setuksimab ve %2,2’si panitumumab almıştı. Ortalama progresyonsuz sağkalım süresi 12,79 ay ortalama genel sağkalım süresi 33,39 ay olarak hesaplandı.
Primer tümör lokalizasyonuna göre değerlendirildiğinde, sağ ve sol kolon tümörleri arasında yaş ve cinsiyet dağılımı açısından farklılık izlenmedi. Hedefe yönelik tedaviler açısından kıyaslandığında, sağ kolon tümörü olan hastaların %60,6’sında anti-VEGF antikoru %6,0’sına (4 hasta) anti-EGFR antikoru tedavisi verildiği görüldü. Sol kolon tümörü olan hastalarda anti- VEGF antikoru tedavisi alan hasta oranı %53,8 anti-EGFR antikoru alan hasta oranı %7,9 idi. Progresyonsuz sağkalım süreleri ortalaması sağ kolon tümörü olan grupta 12,9 ay, sol kolon tümörü olan grupta 12,7 ay olarak hesaplandı (p>0,05). Genel sağkalım sürelerinin ortalamaları sağ kolon tümörü olan grupta 31,4 ay sol kolon tümörü olan grupta 33,6 ay olarak görüldü(p>0,05). Sol kolon kanseri hastalarında k-ras wild tip hasta kolunda hedefe yönelik tedaviler birbirleri ile kıyaslandı. Anti -VEGF antikoru tedavisi alan grupta progresyonsuz sağkalım süresi ortalaması 16,4 ay anti- EGFR antikoru tedavisi alan grupta ise 11,5 ay olarak izlendi (p<0,05). Genel sağkalım sürelerinde bakıldığında anti-VEGF antikoru tedavisi alan grupta ortalama süre 46,2 ay anti- EGFR antikoru tedavisi alan grupta bu süre 42,3 ay olarak görüldü(p>0,05). K-ras wild tip sağ kolon tümörü olan grupta hedefe yönelik tedavi alan hasta sayısı (n<5) test imkanı vermediğinden progresyonsuz sağkalım ve genel sağkalım süreleri çalışılmadı.
Sonuç: Bu çalışma kliniğimizin metastatik kolorektal kanser hastalarına ait tedavi sonuçlarını gözden geçirme, tedavi başarısını değerlendirme ve literatür ile karşılaştırma yapabilmesi açısından önemlidir. Sağ ve sol kolon tümörü olan gruplarda literatür ile benzer progresyonsuz sağkalım ve genel sağkalım sürelerine ulaşılmış olmakla birlikte, iki grup arasında belirgin hasta sayısı farkı olması sebebiyle istatiksel olarak anlamlı farklılık saptanmamıştır.
Introduction: Colorectal carcinomas are the third most common cancer in the men and the second most common cancer in women. It is responsible for 8% of cancer related deaths in worldwide. The most important prognostic factor is the stage of the disease at the time of diagnosis. 20% of colorectal cancers is metastatic at the time of diagnosis. CALBG/SWOG 80405 and FIRE-3 phase 3 studies are revealed that primary tumor localization is a prognostic factor for progression-free-survival and overall survival. In this study we aimed to determine prognostic and predictive effect of primary tumor localization in metastatic colorectal cancer patients whom admitted to medical oncology department of our hospital. Material and Methods: Patients who admitted to Ege University Medical Oncology department between 2010-2015 and diagnosed and treated as metastatic colorectal cancer, included in the study. 1600 patient file was searched, 488 patient data were saved and analyzed. Results: 38,9 % of patients were women and 61,1 % of patients were men. Mean age was 59,8. According to primary tumor localization 86,5 % of patients had left colorectal cancer, 13,5% of patients had right colon cancer.34,6% of patients were found our K-Ras wild type and 26,2% was k-ras mutant. 54,7 % of patients treated with bevacizumab, 5,3% treated with cetuximab and 2,2% treated with panitumumab. Mean progression- free survival was 12,79 months and overall survival was 33,39 months. There was no difference on age and gender according to primary tumor localization. When compared with targeted therapies, 60.6% of patients with right colon tumor were treated with anti-EGFR antibody and 6.0% (4 patients) of anti-VEGF antibody. In patients with left colon tumors, the proportion of patients receiving anti-VEGF antibody therapy was 53.9% and the rate of patients receiving anti-EGFR antibody was 7.9%. Progression-free survival times were calculated as 12.9 months in the right colon tumor group and 12.7 months in the left colon tumor group (p> 0.05). The mean overall survival time was 31.6 months in the right colon tumor group and 33.6 months in the left colon tumor group (p> 0.05). in KRAS wild type patient arm in left colon cancer patients targeted therapies were compared to each other; in the group receiving anti-VEGF antibody treatment, the mean progression-free survival was 16.4 months and 11.5 months in the anti-EGFR antibody therapy group (p <0.05). When the overall survival time was examined, in patients receiving anti-VEGF antibody treatment the overall survival was 46.2 months and in patients receiving anti-EGFR antibody treatment was 42.3 months (p> 0,05). Progression-free survival and overall survival were not studied because insufficient the number of patients receiving targeted therapy in the K-Ras wild type right colon tumor group. Conclusion: Although we reached out similar progression-free survival and overall survival time with the literature, because of the large patient number difference between two groups, results are not meaningful statistically.
Introduction: Colorectal carcinomas are the third most common cancer in the men and the second most common cancer in women. It is responsible for 8% of cancer related deaths in worldwide. The most important prognostic factor is the stage of the disease at the time of diagnosis. 20% of colorectal cancers is metastatic at the time of diagnosis. CALBG/SWOG 80405 and FIRE-3 phase 3 studies are revealed that primary tumor localization is a prognostic factor for progression-free-survival and overall survival. In this study we aimed to determine prognostic and predictive effect of primary tumor localization in metastatic colorectal cancer patients whom admitted to medical oncology department of our hospital. Material and Methods: Patients who admitted to Ege University Medical Oncology department between 2010-2015 and diagnosed and treated as metastatic colorectal cancer, included in the study. 1600 patient file was searched, 488 patient data were saved and analyzed. Results: 38,9 % of patients were women and 61,1 % of patients were men. Mean age was 59,8. According to primary tumor localization 86,5 % of patients had left colorectal cancer, 13,5% of patients had right colon cancer.34,6% of patients were found our K-Ras wild type and 26,2% was k-ras mutant. 54,7 % of patients treated with bevacizumab, 5,3% treated with cetuximab and 2,2% treated with panitumumab. Mean progression- free survival was 12,79 months and overall survival was 33,39 months. There was no difference on age and gender according to primary tumor localization. When compared with targeted therapies, 60.6% of patients with right colon tumor were treated with anti-EGFR antibody and 6.0% (4 patients) of anti-VEGF antibody. In patients with left colon tumors, the proportion of patients receiving anti-VEGF antibody therapy was 53.9% and the rate of patients receiving anti-EGFR antibody was 7.9%. Progression-free survival times were calculated as 12.9 months in the right colon tumor group and 12.7 months in the left colon tumor group (p> 0.05). The mean overall survival time was 31.6 months in the right colon tumor group and 33.6 months in the left colon tumor group (p> 0.05). in KRAS wild type patient arm in left colon cancer patients targeted therapies were compared to each other; in the group receiving anti-VEGF antibody treatment, the mean progression-free survival was 16.4 months and 11.5 months in the anti-EGFR antibody therapy group (p <0.05). When the overall survival time was examined, in patients receiving anti-VEGF antibody treatment the overall survival was 46.2 months and in patients receiving anti-EGFR antibody treatment was 42.3 months (p> 0,05). Progression-free survival and overall survival were not studied because insufficient the number of patients receiving targeted therapy in the K-Ras wild type right colon tumor group. Conclusion: Although we reached out similar progression-free survival and overall survival time with the literature, because of the large patient number difference between two groups, results are not meaningful statistically.
Açıklama
Anahtar Kelimeler
Metastatik Kolorektal Kanseri, Sağ Kolon Kanseri, Sol Kolon Kanseri, Primer Tümör Lokalizasyonu, Birinci Seri Hedefe Yönelik Tedavi, Progresyonsuz Sağkalım, Genel Sağkalım, Metastatic Colorectal Carcinoma, Right Colon Cancer, Left Colorectal Cancer, Primary Tumor Localization, First-Line Targeted Therapy, Progression Free Survival Overall Survival
