Kolorektal kanserlerde prognostik faktörler
Küçük Resim Yok
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
ÖZET AMAÇ EÜTF Hastanesi Genel Cerrahi Kliniği, ülkemizdeki önemli kolorektal bölge hastalıkları merkezlerinden biridir. Klinik bünyesinde kurulmuş olan proktoloji polikliniği, sadece kolorektal ve anal bölge hastalıkları konusunda hizmet vermektedir. Literatür ve temel kaynaklar incelendiğinde, kolorektal bölge kanserlerinde prognostik faktörler ile ilgili çalışmaların, dar kapsamlı olduğu görüldü. Kliniğimizdeki bu potansiyel nedeniyle çalışmamızda, kolorektal bölge kanserlerinde prognostik faktörleri geniş kapsamlı olarak incelemek, bir veri tabanı oluşturmak, sonuçlarımızı değerlendirmek, kolorektal bölge kanserlerinde tedavi ve takibe bilimsel katkıda bulunabilmek amacıyla, bu çalışmayı yapmaya karar verdik. MATERYAL VE METOD Çalışmamızda, 1995-2003 yılları arasında EÜTF G. Cerrahi Proktoloji Bilim Dalı ' nda tedavi ve takipleri yapılan 615 hastanın verileri retrospektif olarak incelendi. Hasta verileri, önceden belirlenmiş parametreleri kaydetmek üzere tarandı. Belirlenen parametreler şunlardı: Yaş, cinsiyet, komorbidite varlığı, yandaş kolorektal hastalık, aile öyküsü, kilo kaybı, rektal kanama, acil başvuru, serum CEA ve Ca 19-9 düzeyleri, tümör lokalizasyonu, komşu organ invazyonu, yapılan operasyon tipi, postoperatif dönemde görülen major ve minör morbidite, tümör tipi ve çapı, lenf nodu metastazı, venöz-perinöral invazyon, Dukes ve MAC sınıflaması, postoperatif dönemdeki adjuvan tedaviler, izlemde lokal nüks, izlemde uzak metastaz ve yaşam süresi. Söz konusu veriler, kategorize edilerek tarama sonuçlan, SPSS for Windows 11.5 programına kaydedildi ve bir kolorektal kanser veri tabanı oluşturuldu. Verileri yeterli olan 448 hasta SPSS for Windows 11.5 programı ile değerlendirildi, istatiksel metod olarak, Kaplan - Meier sürvi analiz testi ve Forward Stepwise yöntemine göre cox regresyon testi kullanıldı. BULGULAR Verileri yeterli olan 448 hastanın; % 56,3' ü erkek, % 43,8' i kadındı. 40 yaş altı hastalar tüm hastaların % 7,8' ini oluşturmaktaydı. Hastaların % 34,4' ünde 1komorbidite, % 23' ünde yandaş kolorektal hastalık ve % 1,8' inde aile öyküsü vardı. Kilo kaybı tüm hastaların % 29,2' sinde, rektal kanama ise 60,3' ünde bulunmaktaydı. Acil başvuru ile gelen hastalar tüm hastaların % 11,2' sini oluşturmaktaydı. Serum CEA düzeyi tüm hastaların % 40,7' sinde, Ca 19-9 ise tüm hastaların % 26,3' ünde yüksekti. Tümörlerin % 57,6' sı rektum, % 42,4' ü kolon yerleşimliydi. Hastaların % 23,9' unda komşu organ invazyonu, % 6' sında minör morbidite ve % 6,9' unda major morbidite vardı. Hastaların % 90' inana küratif cerrahi, % 10' unana palyatif cerrahi uygulandı. Hastaların % 79' unda tipik adenokarsinom, % 16,3' ünde müsin salgılayan adenokarsinom tespit edildi. 1-10 cm çapındaki tümörler tüm hastaların % 95,7' sini, 11-20 cm çapındaki tümörler ise % 4,3' ünü oluşturmaktaydı. Hastaların % 53,1' inde lenf nodu metastazı yokken, % 46,9' unda lenf nodu metastazı ve % 56,3' ünde venöz-perinöral invazyon vardı. Hastaların % 9,8' i Dukes A, % 30,6' sı Dukes B, % 35,3' ü Dukes C, % 24,3' ü Dukes D evresinde bulunmaktaydı. Hastaların % 1 1,4' ünde lokal nüks, % 29,7' sinde uzak nüks görüldü. SONUÇ Çalışmamızda; 24 prognostik faktörden 19' u istatiksel olarak anlamlı ( yaş, komorbidite, yandaş kolorektal hastalık, kilo kaybı, rektal kanama, acil başvuru, serum CEA düzeyi, serum Ca 19-9 düzeyi, komşu organ invazyonu, operasyon tipi, major morbidite, tümörün patolojik tipi, tümör çapı, lenf nodu metastazı, venöz- perinöral invazyon, Dukes sınıflaması, MAC sınıflaması, postoperatif uzak ve lokal nüks ) 5' i anlamsızdı ( cinsiyet, aile öyküsü, tümör lokalizasyonu, minör morbidite, postoperatif adjuvan tedavi ). Yandaş kolorektal hastalık ve rektal kanama hikayesi, pozitif prognostik faktörler olarak saptandı. Sonuç olarak çalışmamızda, prognoz üzerine en etkili faktörler evreleme sistemleriydi ve bulgularımız genel anlamda literatür ile uyumluydu
Aim: Ege University Faculty of Medicine Department of general surgery is one of the most important department for colorectal surgery in Turkey. Proctology policlinic established under general surgery clinic serve for only colorectal and anal region diseases. In the literature and guidelines, it has been observed that the issues about prognostic factors for colorectal cancers are not very comprehensive. In this study our aims were, to research the prognostic factors for colorectal cancers, to establish a database, to review our results and to contribute to scientific studies about treatment and follow up of colorectal cancers. Materials and Methods: The clinicopathologic and follow-up data of 615 patients who hada been treated at our institute between 1995 and 2003 were evauated retrospectively, investigated paramethers were, age, sex, rectal bleeding, presence of comorbidity, serum CEA and CA19-9 levels, family history, localisation of tumor, emergent admission, operation type, invasion to adjacent organs, major and minor morbidity after operation, Dukes and MAC classification, adjuvant therapies in the postoperative period, local nux in the follow-up period, metastasis in the follow-up period, survey. The investigated datas were categorised and results were recorded using SPSS for Windows 11.5 and a database was established for colorectal cancers. Datas of 448 patients whose datas were complete were evaluated with SPSS for Windows 1 1.5. In the statistical analysis cox regression test according to Kaplan- Meier survey method and Forward stepwise method. Results: Of the 448 patients, 56.3% were males and 43.8% were females. 7.8% of the patients were younger than 40 years old. Comorbidity, accompanying other colorectal disease and family history were determined in 34%, 23% and 1.8 of the patients respectively. Weight loss were determined in 29.2% of the patients, Rectal bleeding was detected in 60.3% of the patients. 11.2% of the patients admitted to our clinic in emergent conditions. Serum CEA levels and CA19-9 levels were found over the normal ranges in 40.7% and 26.3% of thepatients respectively. The tumors were localised at rectum in 56.7% and at colon in 42.4% of the patients. 23.9% of the patients had adjacent organ invasion, 6% minor morbidity and 6.9% major morbidity. 90 % of the patients were applied curative resection where 10% had palliative resection. Pathologic examination of the specimens revealed that in 79% of the patients the tumor was typical adenocarsinoma and in 16.3% of the patients was mucin secreting adenocarsinoma. The tumor sizes were between 1-10 cm in 95.7% of the patients and 11-20 cm in 4.3% of the patients. Lymph node metastasis was not detected in 53.1% of the patients. 46.9% of the patients had lymph node metastasis. In 56.3% of the patients venous and perineural invasion were determined. According to Duke classification; 9.8% of the patients were DukeA, 30.6% Duke B, 35.3% Duke C ad 24.3% in Duke D. Local reccurence and distant reccurence were detected in 11.4% and 29.7% of the patients respectively. Conclusion: Of the 24 prognostic factors, 19 were statistically significant (age, comorbidity, accompanying colorectal disease, weight loss, rectal bleeding, emergent admission, serum CEA levels, serum ca 19-9 levels, invasion of the adjacent organs, operation type, pathologic type of the tumor, tumor size, lymph node metastasis, venous- perineural invasion, Dukes classification, MAC classification, local or distant reccurences in the postoperative period). 5 of them were not significant (sex, family history, tumor localisation, minor morbidity, postoperative adjuvant therapy). Accompanying colorectal disease and rectal bleeding were deemed as positive prognostic factors. As a result in this study the most important factors for prognosis were classification systems and our results were similar to the literature.
Aim: Ege University Faculty of Medicine Department of general surgery is one of the most important department for colorectal surgery in Turkey. Proctology policlinic established under general surgery clinic serve for only colorectal and anal region diseases. In the literature and guidelines, it has been observed that the issues about prognostic factors for colorectal cancers are not very comprehensive. In this study our aims were, to research the prognostic factors for colorectal cancers, to establish a database, to review our results and to contribute to scientific studies about treatment and follow up of colorectal cancers. Materials and Methods: The clinicopathologic and follow-up data of 615 patients who hada been treated at our institute between 1995 and 2003 were evauated retrospectively, investigated paramethers were, age, sex, rectal bleeding, presence of comorbidity, serum CEA and CA19-9 levels, family history, localisation of tumor, emergent admission, operation type, invasion to adjacent organs, major and minor morbidity after operation, Dukes and MAC classification, adjuvant therapies in the postoperative period, local nux in the follow-up period, metastasis in the follow-up period, survey. The investigated datas were categorised and results were recorded using SPSS for Windows 11.5 and a database was established for colorectal cancers. Datas of 448 patients whose datas were complete were evaluated with SPSS for Windows 1 1.5. In the statistical analysis cox regression test according to Kaplan- Meier survey method and Forward stepwise method. Results: Of the 448 patients, 56.3% were males and 43.8% were females. 7.8% of the patients were younger than 40 years old. Comorbidity, accompanying other colorectal disease and family history were determined in 34%, 23% and 1.8 of the patients respectively. Weight loss were determined in 29.2% of the patients, Rectal bleeding was detected in 60.3% of the patients. 11.2% of the patients admitted to our clinic in emergent conditions. Serum CEA levels and CA19-9 levels were found over the normal ranges in 40.7% and 26.3% of thepatients respectively. The tumors were localised at rectum in 56.7% and at colon in 42.4% of the patients. 23.9% of the patients had adjacent organ invasion, 6% minor morbidity and 6.9% major morbidity. 90 % of the patients were applied curative resection where 10% had palliative resection. Pathologic examination of the specimens revealed that in 79% of the patients the tumor was typical adenocarsinoma and in 16.3% of the patients was mucin secreting adenocarsinoma. The tumor sizes were between 1-10 cm in 95.7% of the patients and 11-20 cm in 4.3% of the patients. Lymph node metastasis was not detected in 53.1% of the patients. 46.9% of the patients had lymph node metastasis. In 56.3% of the patients venous and perineural invasion were determined. According to Duke classification; 9.8% of the patients were DukeA, 30.6% Duke B, 35.3% Duke C ad 24.3% in Duke D. Local reccurence and distant reccurence were detected in 11.4% and 29.7% of the patients respectively. Conclusion: Of the 24 prognostic factors, 19 were statistically significant (age, comorbidity, accompanying colorectal disease, weight loss, rectal bleeding, emergent admission, serum CEA levels, serum ca 19-9 levels, invasion of the adjacent organs, operation type, pathologic type of the tumor, tumor size, lymph node metastasis, venous- perineural invasion, Dukes classification, MAC classification, local or distant reccurences in the postoperative period). 5 of them were not significant (sex, family history, tumor localisation, minor morbidity, postoperative adjuvant therapy). Accompanying colorectal disease and rectal bleeding were deemed as positive prognostic factors. As a result in this study the most important factors for prognosis were classification systems and our results were similar to the literature.
Açıklama
Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.
Anahtar Kelimeler
Genel Cerrahi, General Surgery