Ahmet TÜRKOĞLU, Ziya ÇETİNKAYA, Mustafa GİRGİN, REFİK AYTEN, BURHAN HAKAN KANAT, Kenan BİNNETOĞLU, Ali AKSU

Kolorektal kanserlerde prognostik faktörler

Amaç: Bu çalışmadaki amacımız kolorektal kanserli hastalarımızda prognostik faktörlerin sağ kalım üzerine etkilerini retrospektif olarak incelemektir. Yöntemler: Fırat Üniversitesi Hastanesi Genel Cerrahi Kliniğinde 1994 ve 2005 yılları arasında kolorektal kanser tanısıyla cerrahi tedavi uygulanan 154 hasta içerisinden 126 hastanın klinik kayıtları, patoloji ve ameliyat raporları geriye dönük olarak incelendi. Hastalarda belirlenen prognostik faktörlerin 2 yıllık, 5 yıllık ve 10 yıllık sağ kalım, genel sağ kalım (GSK) ve hastalıksız sağ kalım (HSK) üzerine etkileri araştırıldı. Sağ kalım süreleri ay olarak hesaplandı. Bulgular: Hastaların 72 (%57,1)si erkek, 54 (%42,9)ü kadın olup yaş ortalaması 57,5 ± 15,2 idi. Ortanca takip süresi 44,5 ay idi. Hastalarda ortanca GSK 60 ay idi. 2,5 ve 10 yıllık GSK oranları sırasıyla %59,5, %46,0 ve %42,9 idi. Ortanca HSK evre I-III kanserli hastalarda 62 ay ve toplamda 40 ay olarak bulundu. Tek değişkenli analizde patolojik evre, kanserin evresi, T evresi, lenf nodu tutulumu, metastaz, cerrahi sınır, preoperatif CEA düzeyi ve uygulanan cerrahi tedavi hem GSK hem de HSK ile ilişkili bulundu. Yaş ve histolojik tip sadece GSK ile ilişkili bulundu. Çok değişkenli analizde kanserin evresi, T evresi ve metastaz GSK ve HSK açısından anlamlı bulunan bağımsız prognostik parametreler olarak değerlendirildi. Sonuç: Kolorektal kanserlerde cerrahi tedavi sonrası sağ kalımı etkileyen çok sayıda prognostik faktör mevcuttur. Sağ kalımı daha isabetli tahmin etmek amacıyla, bağımsız prognostik faktörlerin yanında, diğer prognostik faktörleri de içeren bir skorlama sistemi daha geniş serilerle oluşturulabilir.

Prognostic factors in colorectal cancers

Objective: The aim of this study is to investigate retrospectively the impact of the various prognostic factors on survival in patients with colorectal cancer. Methods: The clinical records, pathology and operation reports of 126 patients in 154 patients operated for colorectal cancer General Surgery Clinic of Fırat University Hospital between 1994 and 2005 years. The effects of the prognostic factors on 2-years, 5-years and 10-years survival, overall survival (OS) and disease-free survival (DFS) were evaluated. The survival durations are presented as months. Results: The mean age was 57.5 ± 15.2. The median duration of follow-up was 44,5 month. The median OS was 60 months. The median DFS in stage I-III patients was 62 months. According to the univariate analysis, the factors found significant in both OS and DFS rates were the following; stage of the cancer, extent of bowel wall penetration, lymph nodes metastasis, distant metastasis, pathologic stage, surgical margin, pretreatment CEA levels and type of surgery. The age and histologic type of tumor were related to only OS. The following variables were independent prognostic factors for both OS and DFS as determined by multivariate analysis; stage of the cancer, extent of bowel wall penetration and distant metastasis. Conclusion: A large number of prognostic factors are available to help predict the outcome of patients with colorectal cancer after surgery. In order to predict survival more accurately, a scoring system can be created that involving not only prognostic factors determined by multivariate analysis, but also prognostic factors determined by univariate analysis.

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