Adjuvan kemoterapi uygulanan invaziv mesane kanseri hastalarında prognostik faktörlerin incelenmesi
Loading...
Date
2013
Authors
Şahbazlar, Mustafa
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmamızda, invaziv mesane kanserli hastalarda adjuvan kemoterapi uygulamasının sağkalım ve rekürrense olan etkilerinin araştırılması ve prognoz üzerine etkili faktörlerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, 2003 ile 2013 yılları arasında invaziv mesane kanseri nedeniyle radikal sistektomi yapılmış olan toplam 62 hasta alınmıştır. Bu hastalar sistektomi sonrası adjuvan kemoterapi alan ve almayanlar olarak iki gruba ayrılmıştır. Bu iki grup genel ve hastalıksız sağkalım süreleri açısından karşılaştırılmış ve prognoz üzerine etkili risk faktörleri, ileri doğru adımsal cox regresyon modeli kullanılarak incelenmiştir. Bulgular: Altmışiki hastadan 40?ı, çoğu cisplatin bazlı kemoterapi rejimlerinden [MVAC/MVEC (metotreksat, vinblastin, doksorubisin/ epirubisin, cisplatin), GC (gemsitabin, cisplatin), GCa (gemsitabin, karboplatin) veya tekli gemsitabin] oluşan adjuvan kemoterapi tedavisi [2-6 kür (median 4)] almıştır. Geri kalan 22 hasta herhangi bir adjuvan tedavi almamıştır. Genel sağkalım süresi kemoterapi grubunda 41,3 ay, kontrol grubunda 69,9 aydı (p=0,227). 5 yıllık hastalıksız sağkalım oranları kemoterapi ve kontrol gruplarında sırasıyla %50,6 ve %59,9 idi (p=0,780). Alt grup analizinde, tümör evresi pT3-4 olan ve lenfovasküler invazyon bulunan hastalarda genel sağkalım oranları kemoterapi grubunda kontrol grubuna göre daha iyi olmasına rağmen aradaki fark anlamlı değildi (45,5 aya karşı 19,5 ay, p=0,104). Lenf nodu metastazı, prognoza etkili tek faktör olarak bulunmuştur. Sonuç: Lenf nodu pozitifliği önemli bir prognostik faktördür. Evre pT3-4 ve lenfovasküler invazyon ile, ve/veya lenf nodu metastazı ile birlikte olan invaziv mesane kanseri adjuvan kemoterapiden özellikle fayda görebilir. Bu alt gruplarda adjuvan kemoterapinin rolü, ileriki randomize çalışmalarda araştırılmalıdır.
The aim of this study is to research the effects of adjuvant chemotherapy on survival and recurrence in patients with invasive urinary bladder cancer, and to investigate the factors which influencing the prognosis. Materials and Methods: A total of 62 patients who had been undergone radical cystectomy due to invasive urinary bladder cancer between the years of 2003 and 2013 were included into the study. These patients were then divided into two groups including the patient treated with adjuvant chemotherapy and no further treatment after cystectomy. These two groups were compared in terms of overall and disease-free survival times and using the forward stepwise cox regression model, possible risk factors on prognosis were investigated. Results: Fourty out of 62 patients received adjuvant chemotherapy [2-6 cycles (median 4)] that was mainly consisted of cisplatin-based chemotherapy regimens [MVAC/MVEC (methotrexate, vinblastine, doxorubicin/epirubicin, cisplatin), GC (gemcitabine, cisplatin), GCa (gemcitabine, carboplatin) or gemcitabine as a mono-therapy]. Remaining 22 patients did not receive any adjuvant treatment. Overall survival time in the chemotherapy group was 41.3 months compared to 69.9 months in the control group (p=0.227). 5-year disease-free survival rates in the chemotherapy and control groups were 50.6% and 59.9%, respectively (p=0.780). Subgroup analysis showed that, in patients who were pT3-4 tumor stages and who had lymphovascular invasion, chemotherapy group showed better overall survival rates compared to the control group (45.5 months vs. 19.5 months, p=0.104), though the difference was not found to be significant. Lymph node metastasis was detected to be the only factor affecting prognosis. Conclusion: Lymph node involvement is an important prognostic factor. In invasive bladder cancer with stage pT3-4 tumors and with lymphovascular invasions, and/or with lymph node metastasis may especially benefit from adjuvant chemotherapy. The exact role of adjuvant chemotherapy in these subpopulations should be investigated in further randomized studies.
The aim of this study is to research the effects of adjuvant chemotherapy on survival and recurrence in patients with invasive urinary bladder cancer, and to investigate the factors which influencing the prognosis. Materials and Methods: A total of 62 patients who had been undergone radical cystectomy due to invasive urinary bladder cancer between the years of 2003 and 2013 were included into the study. These patients were then divided into two groups including the patient treated with adjuvant chemotherapy and no further treatment after cystectomy. These two groups were compared in terms of overall and disease-free survival times and using the forward stepwise cox regression model, possible risk factors on prognosis were investigated. Results: Fourty out of 62 patients received adjuvant chemotherapy [2-6 cycles (median 4)] that was mainly consisted of cisplatin-based chemotherapy regimens [MVAC/MVEC (methotrexate, vinblastine, doxorubicin/epirubicin, cisplatin), GC (gemcitabine, cisplatin), GCa (gemcitabine, carboplatin) or gemcitabine as a mono-therapy]. Remaining 22 patients did not receive any adjuvant treatment. Overall survival time in the chemotherapy group was 41.3 months compared to 69.9 months in the control group (p=0.227). 5-year disease-free survival rates in the chemotherapy and control groups were 50.6% and 59.9%, respectively (p=0.780). Subgroup analysis showed that, in patients who were pT3-4 tumor stages and who had lymphovascular invasion, chemotherapy group showed better overall survival rates compared to the control group (45.5 months vs. 19.5 months, p=0.104), though the difference was not found to be significant. Lymph node metastasis was detected to be the only factor affecting prognosis. Conclusion: Lymph node involvement is an important prognostic factor. In invasive bladder cancer with stage pT3-4 tumors and with lymphovascular invasions, and/or with lymph node metastasis may especially benefit from adjuvant chemotherapy. The exact role of adjuvant chemotherapy in these subpopulations should be investigated in further randomized studies.
Description
Keywords
Mesane kanseri, Adjuvan kemoterapi, Bladder cancer, Adjuvant chemotherapy
Citation
Şahbazlar, M. (2013). Adjuvan kemoterapi uygulanan invaziv mesane kanseri hastalarında prognostik faktörlerin incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.