Prostat kanserli hastalarımız ve sağ kalımı etkileyen prognostik faktörler
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Amaç: Prostat kanserinde sağkalıma etki eden prognostik faktörler genel olarak yaş, performans statüsü, gleason skoru, tümör yaygınlığı, PSA değeri ve diğer biyokimyasal( albumin, ALP, LDH) değerlerdir. Bu çalışmada merkezimizde takip ve tedavi edilen prostat kanserli olguların klinikopatolojik özellikleri, biyokimyasal verileri ve sağkalımı etkileyen prognostik faktörlerin incelenmesi amaçlanmıştır. Gereç-Yöntem: Dicle Üniversitesi Tıp Fakültesi Tıbbi Onkoloji kliniğinde Mart 2003- Ekim 2012 tarihleri arasında izlenen 147 prostat kanserli hastaya ait demografik, klinik, histopatolojik ve biyokimyasal veriler dosya ve hastane kayıtları incelenerek elde edildi. Sağkalıma etkileri olan parametreler; yaş, tümörün evresi, hastanın performans durumu(ECOG performans skalası), komorbid hastalık birlikteliği, gleason skoru, hormon tedavisine direnç varlığı, başvuru anındaki biyokimyasal değerler (PSA, ALP, LDH, kalsiyum, albumin, kreatinin) incelendi ve prostat kanseri gelişimi riski açısından aile öyküsü ve sigara içimi değerlendirildi. Bulgular: Toplam 147 hastaya ait veriler analiz edildi. Hastalarımızda ortanca yaş 68 (50-86) idi. Hastaların %46.9'u 68 yaşından büyük iken ve %53.1'i 68 yaşından küçüktü. Tüm hastalarımızda ortanca sağkalım 25.3 ay idi. 68 yaş ve 68 yaşından küçük olanlarda ortanca sağkalım 25.3 ay iken, 68 yaşından büyük olanlarda ortanca sağkalım 25.1 ay idi. İstatistiksel olarak yaş sağkalım açısından anlamlı bulunmadı (p=0.707). Başvuru şikayeti olarak %50'si ürolojik şikayetler(idrarda kanama, idrarda zorlanma vb.), %42'si sırt ve bel ağrısı ve %8 diğer şikayetlerle başvurdu. Yüz on üç hasta (%59) ECOG 0-1-2 iken, 34 (%41) hastamız ECOG 3-4 olarak başvurdu. ECOG skoru 0-1-2 olanlarda ortanca sağkalım 54.4 ay, ECOG skoru 3-4 olanlarda ortanca sağkalım 29.8 ay idi. Başvurudaki performans durumu, sağkalıma etkili faktör olarak bulundu (p=0.001). Histopatolojik dağılım olarak %97.2'si adenokanser histopatolosine sahipken, %2.8'inde diğer histopatolojik paternler mevcuttu. Ailede birinci derecede yakınlarında kanser öyküsü bulunan hasta sayısı 25 hasta(%17) idi. 52 hasta (%32) sigara tüketicisi idi. En çok eşlik eden hastalık kardiyovsküler hastalıklar olmak üzere, 36 hastamızda (%24.4) eşlik eden komorbid hastalık mevcuttu. Prostat kanserine ek olarak komorbid hastalığı olanlarda ortanca sağkalım 24.2 ay iken komorbid hastalığı olmayanlarda ortanca sağkalım 29.8 ay idi. Komorbid hastalık birlikteliği sağkalıma etki eden faktör olarak anlamlı bulunmadı (p=0.544). Tanı anında hastalarımızın 82 (%56.2) si prostata sınırlı, 64 (%43.8)'ü metastatik olarak tespit edildi. Prostatla sınırlı olanlarda ortanca sağkalım 66.5 ay iken, prostat dışında metastazı olanlarda ise ortanca sağkalım 27.4 ay idi. Prostatla sınırlı veya metastatik kanser olması sağkalıma etkili faktör olarak bulundu (p<0.001). Tanı yöntemi olarak 123 hastada (%84.8) biyopsi yapılırken, 24 hastada (%15.2) cerrahi rezeksiyon yapıldı. Toplamda 113 hastamıza hormon tedavisi verildi. Hormon tedavisi verdiğimiz hastalarımızdan 41'inde hormon tedavisine direnç gelişirken, 72'sinde hormon tedavisine direnç gelişmedi. Hormon tedavisine dirençli olmayanlarda ortanca sağkalım 58.1 ay iken, hormon tedavisine dirençli olanlarda ortanca sağkalım 52.5 idi. Hormon tedavisine direnç gelişimi sağkalıma etkili faktör olarak bulunmadı (p=0.316). Tanı anında PSA<50 olanlarda ortanca sağkalım 59.3 ay PSA>50 olanlarda ortanca sağkalım 43.4 ay idi. Başvuru anındaki PSA değeri sağkalıma etkili faktör olarak bulunmadı (p=0.088). ALP değerleri normal sınırlarda olanlarda ortanca sağkalım 54.9 ay iken, ALP değerleri yüksek tespit edilenlerde ortanca sağkalım 49.1 ay olarak tespit edildi. Başvuru anındaki ALP değerleri sağkalıma etkili faktör olarak anlamlı bulunmadı (p=0.107). LDH değerleri normal sınırlarda olanlarda ortanca sağkalım 62.5 ay iken, LDH değerleri yüksek tespit edilenlerde ortanca sağkalım 34.8 ay olarak tespit edildi. Başvuru anındaki LDH değerleri sağkalıma etkili faktör olarak bulundu (p=0.020). Albümin değerleri >2.5 mg/dl olanlarda ortanca sağkalım 30.1 ay iken, Albümin değerleri <2.5 mg/dl olanlarda ortanca sağkalım 8.5 ay olarak tespit edildi. Tanı anındaki Albümin değerleri sağkalıma etkili prognostik faktör olarak bulundu(p<0.001). Hastalarımızdan Gleason skoru<6 olanlarda ortanca sağkalım 27.9 ay iken, gleason skoru>6 olanlarda ortanca sağkalım 25.1 ay idi. Gleason skoru sağkalıma etkili prognostik faktör olarak bulunmadı (p=0.688). Kalsiyum değerleri yüksek olanlarda ortanca sağkalım 25.1 ay iken kalsiyum değerleri normal sınırlarda olan hastalarda ortanca sağkalım 27.9 ay olarak bulundu. Hastalarımızda başvuru anındaki kalsiyum değerleri ve sağkalım arasında anlama yakın ilişki bulundu (p=0.053). Sonuç. Başvuru anında kanser yaygınlığı, performans durumu, LDH, Kalsiyum düzeyi ve albumin düzeyi prostat kanserli hastalarda sağkalımı etkileyen prognostik faktörler olarak belirlendi. Anahtar sözcükler: Prostat kanseri, sağkalım, prognoz, risk faktörleri
Purposes: Prognostic factors for survival in prostate cancer defined as age ,performance status ,gleason score, extension of tumor, PSA level and other biochemical parameters (calcıum, albumin, ALP, LDH ) İn this study we aimed to investigate the clinicopathologic biochemical features and prognostic factors for survival in patients diagnosed with prostat cancer in our cancer center . Materials –Methode: Clinical data records and follow up cards were analysed of 147 patients diagnosed with prostate cancer between March 2003 and October 2012 in the Dicle University faculty of Medicine Medical Oncology departmen. Demographic parameters clinical histopathological and biochemical data were gathered. Parameters that affect survival such as age stage of tumor performans status gleason score resistance to the hormonal therapy biochemical values( PSA, ALP, LDH, calcium, albumin and kreatinin) during the admission were observed and family history and smoking is evaluated by the risk of prostat cancer development Result: Clinical data /information of 147 patients were analysed . Median age is 68 (50-86 ) %46.9 of patients are older than 68 and %53.1 are under the 68 years. Overall survival was estimated 25.3 months and 25.1 months among patients older than 68 years old. Age was found non significant statistically for survival(P=0.707 ). 50 % of patients has urological complaints ( hematuria urgency etc.) at admission %42 of patients have back pain and %8 of patients were admitted with other problems . 59 (%113)of patients have ECOG performance scale 0-1-2. 34(%41) patients have ECOG score of 3-4 . Median survival time was estimated 54.4 months for patients with ECOG 0-1-2 whereas 29.8 months for patients with ECOG 3-4. Performance status at admission was found statistically significant on survival (p=0.001). Histopathology in %97.2 of patients with prostate cancer demonstereted adenocarcinoma subtype and in %2.8 of patients shows other histopathological patterns . 17of patients(%25 ) have positive family history of one degree relative had been diagnosed with cancer before. 32 (%52) of patients are smoker. 24 of patients(%36) has comorbid diseases. The most frequent co morbid condition among our patient population is cardiovascular disease . Median survival for patients with comorbid diseases was estimated 24,2 mo vs 29,8 mo for patients with no comorbid factor . Comorbid factors was not found significant for survival (p=0,544). Median survival was estimated 59.3 months for patients with PSA level under 50 at admission vs 43.4 months for those PSA level>50 .PSA level at admission was not found to be a significant factor for survival (p=0.088) . 56.2 (%82 ) of patients diagnosed with organ confined prostate cancer and 43.8 (% 64)of patients have metastatic cancer at the time of diagnosis .Median survival was estimated 66.5 mo for patients with organ confined prostate cancer compared with 27.4 mo for patients with metastatic cancer .Stage of prostat cancer at admission was considered a significant factor for survival (p<0.001). A fine needle bisopsy was used for %84.8(123) of patients as diagnostic methode and surgical resection was chosen for (24) 15% of patients. 113 patients was treated with hormonal therapy. 41 of 113 patients who treated with hormonal therapy developed resistance to the therapy while 72 patients didn't develop resistance to hormonal therapy Median survival for patients who are sensitive to hormonal therapy was 58,1 mo whereas in patients who developed resistance to hormonal therapy was 52,5 mo Resistance to hormonal therapy was found non-significant for survival(p=0.316). Median survival for patients with normal ALP values at admission was estimated 54.9 mo vs 49.1 mo for patients with elevated ALP levels. ALP level at admission was found non significant value for survival (p=0.107). Median survival for patients with normal LDH values was 62.5 mo vs 34.8 mo for patients with elevated LDH levels ALP level at admission was defined as a significant factor for survival (p=0.020). Median survival for patients with albumin levels >2.5 mg/dl was 30,1 mo whereas for patients with albumin levels under 2.5 mg/dl was 8,5 mo .Albumin level at admission was determined significantly associated with survival (p<0.001). 27 patients have gleason score under 6 and 120 patients have gleason score >120 Median survival for patients with gleason score under 6 was 27,9 month vs 25.1 month for patients with gleason score >120.Gleason score has no significance for survival (p=0.688).Median survival for patients with normal calcium values at admission was estimated 27,9 month vs 25.1 mo for patients with elevated calcium levels Calcium level at admission was associated with significance for survival (p=0.053) Conclusion: Widespread of tumor at admission LDH level Calcium level Albumin level and performace status at admission were identified as prognostic factors for survival for prostate cancer. Keys words: Prostate cancer, survival, prognosis, risk factors
Purposes: Prognostic factors for survival in prostate cancer defined as age ,performance status ,gleason score, extension of tumor, PSA level and other biochemical parameters (calcıum, albumin, ALP, LDH ) İn this study we aimed to investigate the clinicopathologic biochemical features and prognostic factors for survival in patients diagnosed with prostat cancer in our cancer center . Materials –Methode: Clinical data records and follow up cards were analysed of 147 patients diagnosed with prostate cancer between March 2003 and October 2012 in the Dicle University faculty of Medicine Medical Oncology departmen. Demographic parameters clinical histopathological and biochemical data were gathered. Parameters that affect survival such as age stage of tumor performans status gleason score resistance to the hormonal therapy biochemical values( PSA, ALP, LDH, calcium, albumin and kreatinin) during the admission were observed and family history and smoking is evaluated by the risk of prostat cancer development Result: Clinical data /information of 147 patients were analysed . Median age is 68 (50-86 ) %46.9 of patients are older than 68 and %53.1 are under the 68 years. Overall survival was estimated 25.3 months and 25.1 months among patients older than 68 years old. Age was found non significant statistically for survival(P=0.707 ). 50 % of patients has urological complaints ( hematuria urgency etc.) at admission %42 of patients have back pain and %8 of patients were admitted with other problems . 59 (%113)of patients have ECOG performance scale 0-1-2. 34(%41) patients have ECOG score of 3-4 . Median survival time was estimated 54.4 months for patients with ECOG 0-1-2 whereas 29.8 months for patients with ECOG 3-4. Performance status at admission was found statistically significant on survival (p=0.001). Histopathology in %97.2 of patients with prostate cancer demonstereted adenocarcinoma subtype and in %2.8 of patients shows other histopathological patterns . 17of patients(%25 ) have positive family history of one degree relative had been diagnosed with cancer before. 32 (%52) of patients are smoker. 24 of patients(%36) has comorbid diseases. The most frequent co morbid condition among our patient population is cardiovascular disease . Median survival for patients with comorbid diseases was estimated 24,2 mo vs 29,8 mo for patients with no comorbid factor . Comorbid factors was not found significant for survival (p=0,544). Median survival was estimated 59.3 months for patients with PSA level under 50 at admission vs 43.4 months for those PSA level>50 .PSA level at admission was not found to be a significant factor for survival (p=0.088) . 56.2 (%82 ) of patients diagnosed with organ confined prostate cancer and 43.8 (% 64)of patients have metastatic cancer at the time of diagnosis .Median survival was estimated 66.5 mo for patients with organ confined prostate cancer compared with 27.4 mo for patients with metastatic cancer .Stage of prostat cancer at admission was considered a significant factor for survival (p<0.001). A fine needle bisopsy was used for %84.8(123) of patients as diagnostic methode and surgical resection was chosen for (24) 15% of patients. 113 patients was treated with hormonal therapy. 41 of 113 patients who treated with hormonal therapy developed resistance to the therapy while 72 patients didn't develop resistance to hormonal therapy Median survival for patients who are sensitive to hormonal therapy was 58,1 mo whereas in patients who developed resistance to hormonal therapy was 52,5 mo Resistance to hormonal therapy was found non-significant for survival(p=0.316). Median survival for patients with normal ALP values at admission was estimated 54.9 mo vs 49.1 mo for patients with elevated ALP levels. ALP level at admission was found non significant value for survival (p=0.107). Median survival for patients with normal LDH values was 62.5 mo vs 34.8 mo for patients with elevated LDH levels ALP level at admission was defined as a significant factor for survival (p=0.020). Median survival for patients with albumin levels >2.5 mg/dl was 30,1 mo whereas for patients with albumin levels under 2.5 mg/dl was 8,5 mo .Albumin level at admission was determined significantly associated with survival (p<0.001). 27 patients have gleason score under 6 and 120 patients have gleason score >120 Median survival for patients with gleason score under 6 was 27,9 month vs 25.1 month for patients with gleason score >120.Gleason score has no significance for survival (p=0.688).Median survival for patients with normal calcium values at admission was estimated 27,9 month vs 25.1 mo for patients with elevated calcium levels Calcium level at admission was associated with significance for survival (p=0.053) Conclusion: Widespread of tumor at admission LDH level Calcium level Albumin level and performace status at admission were identified as prognostic factors for survival for prostate cancer. Keys words: Prostate cancer, survival, prognosis, risk factors
Açıklama
Anahtar Kelimeler
Prostat kanseri, Prostate cancer, Sağkalım, Survival, Prognoz, Prognosis, Risk faktörleri, Risk factors
