Endometrioid adenokarsinom tanılı postoperatif radyoterapi alan olgularda mikrosatellit instabilitesi (MSI) varlığının prognostik öneminin araştırılması
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Date
2016
Authors
Şahintürk, Kadriye
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada MSI'nın (mikrosatellit instabilitesi) endometrioid adenokanserli olgularda yaş, evre, histolojik grad, nüks, genel sağ kalım gibi parametrelerle ilişkisi incelenmiştir. Amacımız MSI'nın endometrium adenokarsinomunun prognoz, tanı ve tedavisindeki önemini belirlemektir. Ocak 2002-Aralık 2012 arasında Uludağ Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda endometrium adenokanseri tanısıyla postoperatif radyoterapi almış 99 olgu retrospektif olarak incelendi. Olguların ameliyatta alınmış tümöre ait parafin blokları arşivden çıkarıldı. Tümörden DNA izole edildi, PZR'la (polimeraz zincir reaksiyonu) çoğaltıldı. MSI analizi NCI'ın (National Cancer Institute) önerdiği panele göre gerçekleştirildi. İstatistiksel analizde 'IBM SPSS v.20' kullanıldı. Olguların ortalama tanı yaşı 62,7 (±9,32) yaştı. Olgulardan 40'ı evre I, 41'i evre II, 16'sı evre III ve 2'si evre IV idi. 12 olguda rekürrens mevcuttu. 4'ü hastalık ilişkili olmak üzere 11 olgu ex olmuştu. Olguların ortalama genel sağ kalım süresi 116±3,9 ay, hastalıksız sağ kalım süresi 115,4±3,7 aydı. 19 olguda MSI saptandı. Bu olguların yaş ortalaması 58,6 yaştı. MSI olguların daha genç olduğu saptandı (p=0,032). Multivaryant analizde 60 yaş üzeri olmak MSI için koruyucu bir faktör olarak bulundu (p=0,024). Ayrıca MSI ile ileri evre (p=0,014) ve tanıda lenf nodu metastazı varlığı (p=0,012) arasında ilişkili bulundu. MSI ile lokal nüks ve uzak metastaz arasında ilişkisi saptanmadı (p=0,586 ve p=0,141). MSI grubunda ortalama genel sağ kalım 108,43 ay iken MSS (mikrosatellit stabil) grubunda 114,16 aydı fakat istatistiksel anlamlı değildi (p=0,404). Hastalıksız sağ kalıma (p=0,407) da MSI'nın etkisi görülmedi. Literatürde MSI özellikle erken evre endometrium kanserinde kötü prognozla ilişkili görünmektedir. Bu olgularda adjuvan tedaviye kemoterapi eklenmesinin faydalı olabileceği düşünülebilir.
In this study, the relationship between MSI (microsatellite instability) and the parameters such as age, stage, histologic grade, recurrence, over all survival were researched in endometrioid adenocancer patients. Our aim is to determine the importance of MSI in prognosis, diagnosis and treatmant of endometrium adenocarcinoma. Ninety nine patients that received postoperative radiotherapy with the diagnosis of endometrial adenocarcinomas between January 2002-December 2012 in Uludag University Medical Faculty, Department of Radiation Oncology were retrospectively examined. Paraffin blocks which belong to tumor that were taken in surgery of the patients were collected from the archive. DNA was isoleted from tumor, amplified with PCR (polimerase chain reaction). MSI was analyzed with the panel as NCI (National Cancer Institute) recommended. 'IBM SPSS v.20' was used for statistical analysis. The mean age of patients at the diagnosis was 62,7 (±9,32) years. 40 patients were stage I, 41 patients were stage II, 16 patients were stage III and 2 patients were stage IV. 12 patients had recurrence. 11 patient had died and 4 of them were related with the disease. Mean over all survival time was 116±3,9 months, disease free suvival time was 115,4±3,7 months. MSI was detected in 19 patients. The mean age of theese patients was 58,6 years. MSI patients were younger (p=0,032). In multivariant analyzis, being above 60 years old age was found protective for MSI (p=0,024). MSI was also found that is associated with advanced stage (p=0,014) and lymph node metastasis at the diagnose (p=0,012). There was no relation between MSI and neither local recurrence nor distant metastasis (p=0,586 and p=0,141). While mean over all survival time was 108,43 months in MSI group, it was 114,16 months in MSS (microsatellite stable) group. But it was not statistically significant (p=0,404). The effect of MSI also was not seen in disease free survival (p=0,407) . In literature, MSI seems to be associated with poor prognosis in espacially early stages of endometrial cancer. In these patients, it may be considered that addition of chemotherapy in adjuvant treatment can be useful.
In this study, the relationship between MSI (microsatellite instability) and the parameters such as age, stage, histologic grade, recurrence, over all survival were researched in endometrioid adenocancer patients. Our aim is to determine the importance of MSI in prognosis, diagnosis and treatmant of endometrium adenocarcinoma. Ninety nine patients that received postoperative radiotherapy with the diagnosis of endometrial adenocarcinomas between January 2002-December 2012 in Uludag University Medical Faculty, Department of Radiation Oncology were retrospectively examined. Paraffin blocks which belong to tumor that were taken in surgery of the patients were collected from the archive. DNA was isoleted from tumor, amplified with PCR (polimerase chain reaction). MSI was analyzed with the panel as NCI (National Cancer Institute) recommended. 'IBM SPSS v.20' was used for statistical analysis. The mean age of patients at the diagnosis was 62,7 (±9,32) years. 40 patients were stage I, 41 patients were stage II, 16 patients were stage III and 2 patients were stage IV. 12 patients had recurrence. 11 patient had died and 4 of them were related with the disease. Mean over all survival time was 116±3,9 months, disease free suvival time was 115,4±3,7 months. MSI was detected in 19 patients. The mean age of theese patients was 58,6 years. MSI patients were younger (p=0,032). In multivariant analyzis, being above 60 years old age was found protective for MSI (p=0,024). MSI was also found that is associated with advanced stage (p=0,014) and lymph node metastasis at the diagnose (p=0,012). There was no relation between MSI and neither local recurrence nor distant metastasis (p=0,586 and p=0,141). While mean over all survival time was 108,43 months in MSI group, it was 114,16 months in MSS (microsatellite stable) group. But it was not statistically significant (p=0,404). The effect of MSI also was not seen in disease free survival (p=0,407) . In literature, MSI seems to be associated with poor prognosis in espacially early stages of endometrial cancer. In these patients, it may be considered that addition of chemotherapy in adjuvant treatment can be useful.
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Keywords
Endometrium adenokarsinomu, Mikrosatellit instabilitesi, Endometrium adenocarcinoma, Microsatellite instability
Citation
Şahintürk, K. (2016). Endometrioid adenokarsinom tanılı postoperatif radyoterapi alan olgularda mikrosatellit instabilitesi (MSI) varlığının prognostik öneminin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.