Metastatik kolorektal kanser hasta grubunda EGFR inhibitörü kullanan hastaların genel sağkalım, progresyona kadar geçen süre, yanıt oranı ve tedaviye bağlı yan etkiler gibi klinik parametrelerin retrospektif analizi
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Date
2017
Authors
Muti, Aybuke
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Publisher
Uludağ Üniversitesi
Abstract
Kolorektal kanserler en sık görülen kanserlerden biri olup tüm dünyada halen önemli bir mortalite nedenidir. Kolorektal kanser biyolojisindeki gelişmeler ile kemoterapötik ilaçlardaki son dönem gelişmeler sağkalımda uzama sağlamıştır. Çalışmamızda 2000-2016 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Hastanesi Onkoloji Polikliniğinden takipli tanı anında ya da takip sırasında metastatik olan kolorektal kanser hasta grubunda birinci ve ikinci seri tedavide epidermal büyüme faktörü reseptör (EGFR) inhibitörü kullanan hastaların sağkalım analizleri ve sağkalım üzerinde etkili prognostik faktörleri belirlemeyi amaçladık. Çalışmaya Ocak 2000- Ağustos 2016 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Hastanesinde kolorektal kanser tanısı almış ve Tıbbi Onkoloji Bilim Dalı'nda tedavi almış toplam 84 hasta alındı. Tüm hastalarda yaş, komorbid hastalık varlığı, tanı tarihi, evre, tümör lokalizasyonu, tümöre yönelik operasyon öyküsü, operasyon tarihi, neoadjuvant kemoterapi durumu, adjuvant kemoterapi rejimleri, adjuvant kemoterapide EGFR inhibitörü kullanımı ile ortaya çıkan yan etkiler, karaciğer ve akciğer metastazına yönelik metastazektomi durumu, karaciğer metastazı olması durumunda transarteriyel kemoemboliazasyon/ radyofrekans ablasyon işleminin yapılması, radyoterapi durumu, progresyonsuz sağkalım ve genel sağkalım süreleri gibi parametreler ve bu parametrelerin sağkalım ve nüks üzerine olan etkileri değerlendirildi. Hastaların son kontrol tarihleri ya da exitus tarihleri kaydedilerek median progresyonsuz ve genel sağkalımları hesaplandı. Hastaların tanı anında yaşları 23 ile 82 arasında değişmekte olup yaş ortalması 55,16, standart sapması ise 12,37'dir. Hastaların 29'u (%31,9) kadın, 55'i (%60,4) erkekti. Hastaların 26'sı (%28,6) tanı anında evre 1-3 iken takipleri sırasında progrese olan hasta grubudur. Hastaların 58'i (%63,7) tanı anında evre 4'tü. EGFR inhibitörü alan hastaların median progresyonsuz sağkalım (PFS) 11 ay; median genel sağkalım (OS) ise 30 ay olarak saptandı. Primer hastalık lokalizasyonuna göre sağkalım analizi yapıldığında sol kolon yerleşimli hastalarda PFS (12 ay) ve OS (32 ay); sağ kolon yerleşimli hastalara göre ( median PFS 7 ay ve OS 18 ay) anlamlı olarak yüksek bulundu (p=0,029; p<0,004). Primer tümör cerrahisi yapılan hastalarda median PFS (12 ay) ve OS (40 ay); cerrahi yapılmayan hastalara göre (median PFS 6 ay ve OS 17 ay) anlamlı yüksek bulundu (p<0,01). Tümörün lokalizasyonu, primer tümör cerrahisi yapılması, metastazektomi yapılması, neoadjuvant kemoterapi verilmesi ve EGFR inhibitör yan etkisinin görülmesi tek değişkenli analizlerde genel sağkalım üzerinde anlamlı etkisi olduğu saptandı. Çok değişkenli analizde ise lokalizasyonun, metastazektominin ve EGFR inhibitör yan etkisinin varlığında daha fazla sağkalım saptandı. Çalışmamızda tanı anında ya da takibi sırasında metastaz tespit edilen ve tedavisinde EGFR inhibitörü birinci veya ikinci seçim verilmiş olan hastalarda primer tümörün lokalizasyonunun, primer tümör cerrahisinin hem progresyonsuz hemde genel sağkalımdaki etkisi literatür ile uyumlu bulundu. EGFR inhibitörlerinin yan etkisinin görülmesi, neoadjuvant kemoterapi ve akciğer ile karaciğer metastazlarına yönelik metastazektominin genel sağkalım üzerinde etkili prognostik faktörler olduğu belirlendi.
Colorectal cancers are one of the most prevalent cancers and an important mortality cause in the world. There has been some improvement in survival rates with chemotherapeutic drug developments and progress in colorectal cancer biology. In our study we aim to determine survival rates and affecting prognostic factors in the Uludag University Faculty of Medicine Hospital Oncology Department patients that has metastatic colorectal cancer and receive EGFR inhibitor during first or second line of treatment. We retrospectively analysed the clinical outcomes of patients with advanced colorectal cancer who received chemotherapy plus anti-EGFR treatment at Uludag University Faculty of Medicine Department of Medical Oncology between January 2000 and August 2016. The clinical parameters including patients' age, stage, tumor location, chemotherapy types, treatment-related side affects, progression free- and overall-survival times. Patients' mean age was 55.16±12.37 with minimum 23 and maximum 82. Among patiens 29 of them (31.9%) were female and 55 of them were male (60.4%). 26 of the patients (28.6%) who were stage 1-3 at diagnose than progressed during their follow-up. 58 of the patients (63.7%) were stage 4 at the time they were diagnosed. Median progression free survival (PFS) was 11 months and median overall survival (OS) was 30 months for the patients that receive EGFR inhibitor. When the survival analysis conducted for the localization of the tumor; median PFS was 12 months and OS was 32 months for left colon, median PFS was 7 and OS was 18 months for right colon and it was statistically significant (PFS p=0.029; OS p=0.004). Among the patients who had primary tumor surgery median PFS was 12 and OS was 10 months wheras for the patients who had not have any surgery PFS was 6 and OS was 17 months; and the difference was statistically significant (p<0.001). In the univariate analysis the factors that affect general survival were localization of tumor, primary tumor surgery, metastasectomy, neoadjuvant chemotherapy, having adverse effects from EGFR inhibitors. In the multivariate analysis localization of tumor, metastasectomy and having adverse effects from EGFR inhibitors were found as predictive factors for prolonged survival. We found primary tumor location and primary tumor surgery as predictive factors for prolonged survival in the patients that has metastatic colorectal cancer and receive EGFR inhibitor during first or second course of treatment; and that was consistent with literature. Also we determined adverse effects from EGFR inhibitors, neoajuvant chemotherapy and metastasectomy from lung/liver as prognostic factors for survival.
Colorectal cancers are one of the most prevalent cancers and an important mortality cause in the world. There has been some improvement in survival rates with chemotherapeutic drug developments and progress in colorectal cancer biology. In our study we aim to determine survival rates and affecting prognostic factors in the Uludag University Faculty of Medicine Hospital Oncology Department patients that has metastatic colorectal cancer and receive EGFR inhibitor during first or second line of treatment. We retrospectively analysed the clinical outcomes of patients with advanced colorectal cancer who received chemotherapy plus anti-EGFR treatment at Uludag University Faculty of Medicine Department of Medical Oncology between January 2000 and August 2016. The clinical parameters including patients' age, stage, tumor location, chemotherapy types, treatment-related side affects, progression free- and overall-survival times. Patients' mean age was 55.16±12.37 with minimum 23 and maximum 82. Among patiens 29 of them (31.9%) were female and 55 of them were male (60.4%). 26 of the patients (28.6%) who were stage 1-3 at diagnose than progressed during their follow-up. 58 of the patients (63.7%) were stage 4 at the time they were diagnosed. Median progression free survival (PFS) was 11 months and median overall survival (OS) was 30 months for the patients that receive EGFR inhibitor. When the survival analysis conducted for the localization of the tumor; median PFS was 12 months and OS was 32 months for left colon, median PFS was 7 and OS was 18 months for right colon and it was statistically significant (PFS p=0.029; OS p=0.004). Among the patients who had primary tumor surgery median PFS was 12 and OS was 10 months wheras for the patients who had not have any surgery PFS was 6 and OS was 17 months; and the difference was statistically significant (p<0.001). In the univariate analysis the factors that affect general survival were localization of tumor, primary tumor surgery, metastasectomy, neoadjuvant chemotherapy, having adverse effects from EGFR inhibitors. In the multivariate analysis localization of tumor, metastasectomy and having adverse effects from EGFR inhibitors were found as predictive factors for prolonged survival. We found primary tumor location and primary tumor surgery as predictive factors for prolonged survival in the patients that has metastatic colorectal cancer and receive EGFR inhibitor during first or second course of treatment; and that was consistent with literature. Also we determined adverse effects from EGFR inhibitors, neoajuvant chemotherapy and metastasectomy from lung/liver as prognostic factors for survival.
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Keywords
Metastatik kolorektal kanser, EGFR inhibitörleri, Prognostik faktörler, Metastatic colorectal cancer, EGFR inhibitors, Prognostic factors
Citation
Muti, A. (2017). Metastatik kolorektal kanser hasta grubunda EGFR inhibitörü kullanan hastaların genel sağkalım, progresyona kadar geçen süre, yanıt oranı ve tedaviye bağlı yan etkiler gibi klinik parametrelerin retrospektif analizi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.