Metastatik over kanserli hastalarda hormon reseptör durumunun prognoz ve tedavi yanıtı ilişkisinin retrospektif olarak değerlendilmesi
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Tarih
2020
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Over kanseri jinekolojik kanserler arasında görülme sıklığı açısından ikinci, ölüm nedenleri açısından birinci sıradadır. Dünya genelinde yılda yaklaşık 239.000 kişi over kanseri tanısı alırken 152.000 kişi over kanserine bağlı nedenlerle hayatını kaybetmektedir. Sıklıkla ileri evrelerde tanı konulan hastalıkta 5 yıllık mortalite %50 civarındadır. Over kanserlerinin %95'i yüzeyel epitelyal kökenli kanserlerdir. Over kanserlerinin çok büyük bir kısmı Östrojen (ER) ve progesteron reseptörü(PR) taşımaktadır. Meme kanserindeki duruma benzer olarak, ER ve PR pozitifliği ile over kanseri prognozu arasındaki ilişkiyi inceleyen çalışmalar yapılmış ve farklı sonuçlar elde edilmiştir. METOD: Çalışmamıza 2010-2017 yılları arasında Ege Üniversitesi Tıp Fakültesi Onkoloji Bilim Dalı'nda takip edilen hastalar dahil edildi. Bu hastaların demografik bilgileri, histolojik alt tipleri, ER ve PR durumları, metastaz ve lenf nodu durumları, takip süreçleri, tedavileri, tedavi yanıtları, sağkalım verileri kaydedildi. BULGULAR: Çalışmaya 189 hasta dahil edildi. Hastaların yaş ortalaması 54.4±10.9' tü. Hastaların %11.7 si evre 1, %12.1'i evre 2, %52.4'ü evre 3, %23.8'i evre 4'tü. Hormon reseptör durumlarına bakıldığında 57 si ER+,PR+, 83'ü ER+ PR-, 6'sı ER-PR+, 43'ü ER-PR- 'ti. Hastaların 11'i(%5.9) DDSOK, 109'u(%58.3) YDSOK, 16'sı (%8.6) MK, 10'u (%5.3) EK, 19'u(%10.2) BHK, 22'si (%11.8) mikst histolojideydi. 38 hastada tanıda metastaz mevcutken 151 hastanın tanı anında uzak metastazı yoktu. 5 yıllık sağ kalım %50 olarak saptanırken sağkalımın en önemli belirteci evre olarak izlendi. ER ve PR'ye göre oluşan dört alt grup (ER+PR+, ER+PR-,ER-PR+,ER-PR-) arasında istatistiksel olarak anlamlı sağkalım farkı saptanmadı. Hormon pozitif hastalarda tanı anında belirgin olarak daha fazla lenf nodu pozitifliği mevcuttu. PR pozitifliğine göre analiz yapıldığında PR+ grubun sağ kalımı PR - gruba göre anlamlı olarak daha iyiydi. Yine PR+ grubun tedavi sonrası nüks süreleri de PR- gruptan daha uzundu. SONUÇ: Hasta grubumuzda PR pozitif grubunun belirgin olarak daha iyi prognoza sahip olduğu saptandı. Bu grubun çok önemli bir kısmının ER+PR+ gruptan olması nedeniyle reseptörlerin birlikte pozitifliğinin bu sonucu doğurduğu söylenebilir. ER-PR+ grubun sayı olarak az olması nedeniyle ER+ PR+ grupla karşılaştırılması yapılamamıştır. ER pozitifliği tek başına prognostik anlamlı olmasa da hormon pozitif hastaların sağ kalımı daha iyidir. Histoloji gruplarına göre ayrı ayrı analiz sayı yetersizliği nedeniyle yapılamamıştır. Özetle PR pozitifliğinin olumlu bir prognoz göstergesi olduğu sonucu çıkarılmakla beraber bu sonucu destekleyecek prospektif, geniş ölçekli çalışmalara ihtiyaç vardır.
INTRODUCTION: Ovarian cancer ranks second in terms of frequency among gynecological cancers and first in terms of causes of death. Around 239,000 people worldwide are diagnosed with ovarian cancer annually, while 152,000 people die due to ovarian cancer. 5-year mortality is about 50% in the disease. Ovarian cancer is frequently diagnosed in advanced stages. 95% of ovarian cancers are superficial epithelial cancers. The vast majority of ovarian cancers carry estrogen (ER) and progesterone receptors (PR). Similar to the situation in breast cancer, studies examining the relationship between ER, PR positivity and the prognosis of ovarian cancer have been conducted and different results have been obtained. METHOD: Patients who were followed up in Ege University Medical Faculty Oncology Department between 2010-2017 were included in our study. Demographic information, histological subtypes, ER and PR conditions, metastasis and lymph node conditions, follow-up processes, treatments, treatment responses, survival data were recorded. RESULTS: 189 patients to the study. The mean age of the patients was 54.4 ± 10.9. 11.7% of the patients were stage 1, 12.1% were stage 2, 52.4% were stage 3, 23.8% were stage 4. Considering the hormone receptor status, 57 were ER +, PR +, 83 were ER + PR-, 6 were ER-PR +, 43 were ER-PR-. 11 (5.9%) of the patients were LGSOC, 109 (58.3%) were HGSOC, 16 (8.6%) were MC, 10 (5.3%) were EC, 19 (10.2%) were CCC, 22 ( 11.8%) mixed in histology. While 38 patients had metastases in the diagnosis, 151 patients did not have distant metastases at the time of diagnosis. While 5-year survival was 50%, the most important marker of survival was observed as stage. There was no significant survival difference between ER PR groups. Significantly higher lymph node positivity was present at the time of diagnosis in hormone positive patients. When analysis was made according to the PR positivity, the survival of the PR + group was significantly better than that of the PR - group. The recurrence times of the PR + group were longer than the PR- group. CONCLUSION: In our patient group, the PR positive group had a significantly better prognosis. Since a very important part of this group is from the ER + PR + group, it can be said that positivity of the both receptors results in this outcome. Since the ER-PR + group was few in number, it could not be compared with the ER + PR + group. Although ER positivity alone is not prognostic, hormone-positive patients survive better. According to histology groups, the analysis could not be done separately due to the insufficient number. In summary, it is concluded that PR positivity is a positive prognosis, but prospective, large-scale studies are needed to support this result.
INTRODUCTION: Ovarian cancer ranks second in terms of frequency among gynecological cancers and first in terms of causes of death. Around 239,000 people worldwide are diagnosed with ovarian cancer annually, while 152,000 people die due to ovarian cancer. 5-year mortality is about 50% in the disease. Ovarian cancer is frequently diagnosed in advanced stages. 95% of ovarian cancers are superficial epithelial cancers. The vast majority of ovarian cancers carry estrogen (ER) and progesterone receptors (PR). Similar to the situation in breast cancer, studies examining the relationship between ER, PR positivity and the prognosis of ovarian cancer have been conducted and different results have been obtained. METHOD: Patients who were followed up in Ege University Medical Faculty Oncology Department between 2010-2017 were included in our study. Demographic information, histological subtypes, ER and PR conditions, metastasis and lymph node conditions, follow-up processes, treatments, treatment responses, survival data were recorded. RESULTS: 189 patients to the study. The mean age of the patients was 54.4 ± 10.9. 11.7% of the patients were stage 1, 12.1% were stage 2, 52.4% were stage 3, 23.8% were stage 4. Considering the hormone receptor status, 57 were ER +, PR +, 83 were ER + PR-, 6 were ER-PR +, 43 were ER-PR-. 11 (5.9%) of the patients were LGSOC, 109 (58.3%) were HGSOC, 16 (8.6%) were MC, 10 (5.3%) were EC, 19 (10.2%) were CCC, 22 ( 11.8%) mixed in histology. While 38 patients had metastases in the diagnosis, 151 patients did not have distant metastases at the time of diagnosis. While 5-year survival was 50%, the most important marker of survival was observed as stage. There was no significant survival difference between ER PR groups. Significantly higher lymph node positivity was present at the time of diagnosis in hormone positive patients. When analysis was made according to the PR positivity, the survival of the PR + group was significantly better than that of the PR - group. The recurrence times of the PR + group were longer than the PR- group. CONCLUSION: In our patient group, the PR positive group had a significantly better prognosis. Since a very important part of this group is from the ER + PR + group, it can be said that positivity of the both receptors results in this outcome. Since the ER-PR + group was few in number, it could not be compared with the ER + PR + group. Although ER positivity alone is not prognostic, hormone-positive patients survive better. According to histology groups, the analysis could not be done separately due to the insufficient number. In summary, it is concluded that PR positivity is a positive prognosis, but prospective, large-scale studies are needed to support this result.
