Metastatik meme kanserli hastalarda prognostik faktörler
Loading...
Date
2010
Authors
Kaplan, Şenay
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı metastatik meme kanserli olgularda sağkalım üzerinde etkili olabilecek prognostik etmenleri belirlemektir. Ekim 1995- Aralık 2007 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi (UÜTF) Muammer Ağım Radyoterapi Merkezi‟nde meme kanseri tanısıyla adjuvan radyoterapi (RT) uygulanan ve baĢlangıçta metastatik olmayıp izlemleri sırasında metastaz saptanan 125 olgu retrospektif olarak değerlendirildi. Olguların ortanca ilk tanı yaĢı 47 (aralık: 24-83) olup 124‟ ü kadın, 1‟i erkekti. Metastaz sonrası genel ve hastalığa özgü sağkalım üzerinde etkili olabileceği öngörülen etmenler kiĢisel, tümöral ve tedaviyle ilgili parametreler olmak üzere üç grupta incelendi. KiĢisel etmenler; yaĢ ve menapoz durumu, tümöral etmenler; tümör çapı, lenf nodu metastazı, histolojik ve nükleer grade, lenfovasküler ve perinöral invazyon, östrojen ve progesteron reseptör durumu, c-erbB2 ekspresyonu ve tedaviyle ilgili etmenler; cerrahi tipi, radyoterapi alanları ve dozu, adjuvan kemoterapi ve hormonoterapi uygulanıp uygulanmaması idi. Ġstatistiksel değerlendirmede tek değiĢkenli analizlerde Kaplan-Meier Log Rank testi, beĢ ve on yıllık sağkalım oranlarının hesaplanmasında YaĢam Süresi Tabloları kullanıldı. Çok değiĢkenli analizde ise Cox regresyon testi uygulandı. Ġstatistiksel anlamlı değer olarak p ≤ 0.05 kabul edildi. Metastaz Sonrası Genel Sağkalım Süresi (MSGSS) ortanca 17 ay (aralık:1,5-122 ay) olup YaĢam Süresi Tabloları kullanılarak elde edilen 5 ve 10 yıllık Metastaz Sonrası Genel Sağkalım Oranları (MSGSO), sırasıyla, %21 ve %17 olarak hesaplandı. Metastaz Sonrası Hastalığa Özgü Sağkalım Süresi (MSHÖSS) 5 ve 10 yıllık oranları sırasıyla %37 ve %22 idi. Tek değiĢkenli analizlerde MSGSS için istatistiksel anlamlı prognostik faktörler; östrogen reseptörü (ER) (p=0.022), progesteron reseptörü (PR) (p=0.015), histolojik tip (p=0.027), histolojik grade (p=0.001), kan damarı invazyonu (p=0.040), lenfatik damar invazyonu (p=0.019), metastatik lenf nodu çapı (p=0.017), nodal nüks (p=0.047), metastaz zamanı (p=0.007), uzak metastaz yeri (p=0.011), metastatik bölge sayısı (p=0.025) ve uzak metastaz için kemoterapi (KT) almıĢ olmak (p=0.000) idi. MSHÖSS için istatistiksel anlamlı prognostik faktörler ise; ER (p=0.018), PR (p=0.010) , histolojik tip (p=0.013), histolojik grade (p=0.001), kan damarı invazyonu (p=0.013), lenfatik damar invazyonu (p=0.023), nodal nüks (p=0.033), metastaz zamanı (p=0.003), uzak metastaz yeri (p=0.021), metastatik bölge sayısı (p=0.015) ve uzak metastaz için KT uygulanması (p=0.001) olarak belirlendi. Sonuç olarak; olgu grubumuzda; Metastaz sonrası genel sağkalım ve metastaz sonrası hastalığa özgü sağkalım sürelerinin her ikisine birden etkili faktörleri, primer tümörün biyolojik özelliklerinden; histolojik tip, histolojik grade, hormon reseptör durumu, lenfovasküler invazyon, klinik faktörlerden ise uzak metastaz için KT almıĢ olmak, uzak metastaz zamanı, metastaz yeri, metastatik bölge sayısı ve nodal nüks olarak saptadık. Metastatik lenf nodu çapı MSGSS üzerine etkili iken MSHÖSS üzerinde anlamlı etkisi saptanamadı. Anahtar kelimeler: Metastatik meme kanseri, sağkalım, prognostik etmen.
The aim of the study was to determine the prognostic factors for the cases with metastatic breast cancer that effect the overall and cause specific survival. One hundred twenty five cases with metastatic breast cancer who had been treated adjuvant radiotherapy (RT) before metastases at the Uludag University Faculty of Medicine (Muammer Agim Radiotherapy Center), between October 1995 and December 2007, were evaluated retrospectively The median age at diagnosis was 47 (range, 24-83) and of all 124 were female. The predictive factors that may effect both postmetastatic disease specific survival and overall survival were analysed in three groups as individual, tumoral, and treatment related parameters. The individual, tumor and treatment parameters were; age, menopause status; the size of tumor, lymph node metastases, histological and nuclear grade, lymphovascular and perineural invasion, estrogen and progestron receptors (ER and PR) status, c-erb B2 expression; surgical procedures, RT treatment fields and dose, whether to use of adjuvant chemotherapy and hormonotherapy, respectively. In StatisticaI analysis Kaplan-Meier log rank test in univariate and Cox Regression test in multivariate analyses were used. Five and 10-year survival rates were calculated by using Life Time Table. A p value of ≤0.05 was considered as statistically significant. Postmetastatic disease free survival time (PMDFS) was median 17 months (range: 1.5-122 months). Five and 10-years postmetastatic overall survival (PMOS) and postmetastatic disease spesific survival (PMDSS) rates were 21% and 17%, 37% and 22%, respectively. The presence of ER (p=0.022) and PR (p=0.015), histopathology (p=0.027), histologic grade (p=0.001), lymphovascular invasion (p=0.040), lymphatic vessel invasion (p=0.019), the size of metastatic lymph node (p=0.017), the presence of nodal recurrence (p=0.047), time of metastatic disease (p=0.007), the sites of distant metastases (p=0.011), the number of metastatic involvements (p=0.025) and to receive chemotherapy for metastatic disease (p=0.000) were statistically significant for PMOS. Similarly, the presence of ER (p=0.018) and PR (p=0.010), histopathology (p=0.013), histologic grade (p=0.001), lymphovascular invasion (p=0.013), lymphatic vessel invasion (p=0.023), the presence of nodal recurrence (p=0.033), time of metastatic disease (p=0.003), the sites of distant metastates (p=0.015) and chemotherapy (0.001) were found to be statistically significant prognostic factors for PMDSS. As conclusion, the tumor characteristics such as; histopathological type, histologic grade, hormon receptor status, lymphovascular invasion and clinical factors such as receiving chemotherapy, the time and sites of metastatic disease, the number of metastatic sites, the presence of nodal recurrence were demonstrated as prognostic factors for both PMOS and PMDSS. As the size of metastatic lymph node was found to be statiscally significant for PMOS, no correlation found with PMDSS. Key words: Metastatic, breast cancer, survival, prognostic factors.
The aim of the study was to determine the prognostic factors for the cases with metastatic breast cancer that effect the overall and cause specific survival. One hundred twenty five cases with metastatic breast cancer who had been treated adjuvant radiotherapy (RT) before metastases at the Uludag University Faculty of Medicine (Muammer Agim Radiotherapy Center), between October 1995 and December 2007, were evaluated retrospectively The median age at diagnosis was 47 (range, 24-83) and of all 124 were female. The predictive factors that may effect both postmetastatic disease specific survival and overall survival were analysed in three groups as individual, tumoral, and treatment related parameters. The individual, tumor and treatment parameters were; age, menopause status; the size of tumor, lymph node metastases, histological and nuclear grade, lymphovascular and perineural invasion, estrogen and progestron receptors (ER and PR) status, c-erb B2 expression; surgical procedures, RT treatment fields and dose, whether to use of adjuvant chemotherapy and hormonotherapy, respectively. In StatisticaI analysis Kaplan-Meier log rank test in univariate and Cox Regression test in multivariate analyses were used. Five and 10-year survival rates were calculated by using Life Time Table. A p value of ≤0.05 was considered as statistically significant. Postmetastatic disease free survival time (PMDFS) was median 17 months (range: 1.5-122 months). Five and 10-years postmetastatic overall survival (PMOS) and postmetastatic disease spesific survival (PMDSS) rates were 21% and 17%, 37% and 22%, respectively. The presence of ER (p=0.022) and PR (p=0.015), histopathology (p=0.027), histologic grade (p=0.001), lymphovascular invasion (p=0.040), lymphatic vessel invasion (p=0.019), the size of metastatic lymph node (p=0.017), the presence of nodal recurrence (p=0.047), time of metastatic disease (p=0.007), the sites of distant metastases (p=0.011), the number of metastatic involvements (p=0.025) and to receive chemotherapy for metastatic disease (p=0.000) were statistically significant for PMOS. Similarly, the presence of ER (p=0.018) and PR (p=0.010), histopathology (p=0.013), histologic grade (p=0.001), lymphovascular invasion (p=0.013), lymphatic vessel invasion (p=0.023), the presence of nodal recurrence (p=0.033), time of metastatic disease (p=0.003), the sites of distant metastates (p=0.015) and chemotherapy (0.001) were found to be statistically significant prognostic factors for PMDSS. As conclusion, the tumor characteristics such as; histopathological type, histologic grade, hormon receptor status, lymphovascular invasion and clinical factors such as receiving chemotherapy, the time and sites of metastatic disease, the number of metastatic sites, the presence of nodal recurrence were demonstrated as prognostic factors for both PMOS and PMDSS. As the size of metastatic lymph node was found to be statiscally significant for PMOS, no correlation found with PMDSS. Key words: Metastatic, breast cancer, survival, prognostic factors.
Description
Keywords
Metastatik meme kanseri, Sağkalım, Prognostik etmen, Metastatic, Breast cancer, Survival, Prognostic factors
Citation
Kaplan, Ş. (2010). Metastatik meme kanserli hastalarda prognostik faktörler. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.