Mide kanseri hastalarında malnütrisyon ve sarkopeni ile ilişkili prognostik indekslerin mortalite üzerine etkisinin incelenmesi
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İzmir Bakırçay Üniversitesi Lisansüstü Eğitim Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Mide kanseri hastaları sıklıkla lokal ileri veya metastatik hastalıkla başvurur ve tedavide amaç palyasyonu sağlamaktır. Hastalarda kaşeksi ve sarkopeni çoğunlukla görülür ve bunlar kötü prognozu belirleyen faktörlerdir. Çalışmamızda mide kanseri vakalarında inflamatuar indekslerin modifiye Glasgow prognostik indeksi(mGPS) [1] , prognostik indeks (PI), prognostik nütrisyonel indeks (PNI), geriatrik beslenme riski indeksi (GNRI), nötrofil lenfosit oranı (NLR) ve sistemik inflamasyon indeksi(SII)'nin prognostik değerlerinin araştırılması amaçlandı. Metod: Bakırçay Üniversitesi Çiğli Eğitim ve Araştırma Hastanesi Tıbbi Onkoloji Polikliniğine Kasım 2020 ile Kasım 2023 tarihleri arasında başvuran mide kanseri tanılı hastaların tetkikleri restrospektif olarak tarandı ve gerekli verileri tam olan 81 hasta çalışmaya dahil edildi. PI, PNI, GNRI, mGPS ,NLR,SII belirteçleri sırasıyla, CRP- hemogram, albümin-hemogram, albümin-vücut ağırlığı, CRP-hemogram, sadece hemogram tetkikleri kullanılarak hesaplandı. Hastaların NLR ölçümlerinin medyan değeri NLR cut off değeri olarak kabul edildi. Bu parametreleri etkileyecek diğer nedenler ekarte edildi. İstatistiksel analiz, SPSS (version 25.0) programı ile yapıldı. İndekslerin mortalite öngörmedeki değerleri, ROC analizi ile AUC hesaplanarak kaydedildi ve birbirleriyle kıyaslandı. Bulgular: 81 hastanın ortalama takip süresi 43.48± 38.05 (medyan=33 hafta) idi. Kasım 2020 ile Aralık 2023 tarihleri arasındaki takiplerinde 81 hastanın 30'unda (%37) exitus gelişti. Hastaların ortalama yaş ve vücut kitle indeksi (VKİ) sırasıyla 63.90 ± 11.23 yıl ve 24.22 ± 4.79 kg/m2 olarak bulundu. Hastaların büyük çoğunluğu 60-85 yaşları arasındaydı (%65.4). 81 hastanın 51'i erkekti. Medyan yaşı 66 idi. Hastaların ortanca sağkalım süresi 83,85 hafta (77.12-90.58) idi. Tek değişkenli analize göre, metastaz varlığı, cerrahi öykü, GNRI, NLR, PI, mGPS, PNI ve SII varlığının sağkalım üzerinde anlamlı bir etkisi olduğu, cinsiyet, yaş (66 yaş altı ve üstü), VKİ (24 yaş altı ve üstü)'nin sağkalım üzerinde anlamlı bir etkisi olmadığı bulundu. Laboratuvar değerlerinin tek değişkenli sağkalım analizi üzerine etkisi incelendiğinde, lökosit (WBC), nötrofil ve albümin değerlerinin sağkalım üzerine anlamlı bir etkisi vardı (p<.005). Hb, lenfosit ve GFR'nin etkisi anlamlı değildi. Albümin, WBC, nötrofiller ve lenfositler Backward LR yöntemi kullanılarak çok değişkenli Cox regresyon modeline dahil edildiğinde, model anlamlı bulundu χ 2 (3) =21.394, p<.001. Bununla birlikte, sadece albümin çok 6 değişkenli analizde sağkalım üzerinde anlamlı bir etkiye sahipti (B: 1.476, S.E: .47, p<.001, Exp (B)=4.374 (%95 CI: 1.717, 11.145). Sonuç: Çalışmamızda mide kanseri hastalarında mGPS, PNI ve GNRI skorunun düşük sağkalımı göstermede bağımsız göstergeler olduğu saptandı. Sadece CRP, albümin, vücut ağırlığı ve tam kan sayımı verileri ile çok kısa sürede hesaplanabilen mGPS, PNI ve GNRI klinik pratikte mide kanseri hastalarında genel sağkalımı öngörmede ucuz, kullanışlı ve yararlı yöntemler olabilir. Sarkopeninin kanser hastalarında prognoza etkisinin ve indekslerin prognoza etkisinin tam olarak anlaşılabilmesi için daha geniş çaplı prospektif çalışmalara ihtiyaç vardır.
Objectives: Gastric cancer patients often present with locally advanced or metastatic disease, and the aim of treatment is to provide palliation. Cachexia and sarcopenia are often seen in patients and this is one of the factors that determine the poor prognosis. The aim of our study was to investigate the prognostic values of inflammatory indices [modified Glasgow prognostic index [1] , prognostic index (PI), prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and neutrophil lymphocyte ratio (NLR)] in gastric cancer patients. Methods: The examinations of patients diagnosed with gastric cancer who applied to Bakırçay University Çiğli EAH Medical Oncology Outpatient Clinic between November 2020 and November 2023 were restrospectively screened and 81 patients with complete data were included in the study. PI, PNI, GNRI, mGPS and NLR markers were calculated using CRP-hemogram, albumin-hemogram, albumin-body weight, CRP-hemogram, hemogram tests alone, respectively. The median value of the NLR measurements of the patients was accepted as the NLR cut-off value. The calculation times of the indices were recorded. Other causes that would affect these parameters were ruled out. Statistical analysis was performed with SPSS (version 25.0) program. The mortality prediction values of the indices were recorded by calculating AUC by ROC analysis and compared with each other. Results:Median follow-up period of eighty-one patients The mean follow-up period was 43.48± 38.05 (median=33 weeks). During their follow-up between November 2020 and December 2023, 30 of 81 patients (37%) developed exitus. The mean age and body mass index [2] of the patients were 63.90± 11.23 years and 24.22± 4.79 kg/m2, respectively. The majority of the patients were between the ages of 60-85 (65.4%). Of the 81 patients, 51 were male. The median age was 66 years. Median survival time of patients was 83.85 weeks (77.12-90.58). According to the univariate analysis, the presence of metastasis, surgical history, GNRI, NLR, PI, mGPS, PNI, KI, and SII were found to have a significant effect on survival, whereas gender, age (below 66 vs. above), 8 BMI (below 24 vs. above) had no significant effect on survival. When the effect of laboratory values on univariate survival analysis was analyzed, WBC, neutrophil, and albumin values had a significant effect (p<.05) on survival. The effect of Hb, lymphocyte, and GFR was not significant. When albumin, WBC, neutrophils, and lymphocytes were included in the multivariate Cox regression model using the Backward LR method, the model was significant χ 2 (3) =21.394, p<.001. However, only albumin (threshold:<34<) had a significant effect on survival (B: 1.476, S.E: .47, p<.001, Exp(B)=4.374 (95% CI: 1.717, 11.145). Conclusions: In our study, mGPS, PNI and GNRI scores were found to be independent indicators of low survival in gastric cancer patients. mGPS, PNI and GNRI, which can be calculated in a very short time with only CRP, albumin, body weight and complete blood count data, can be cheap, useful and useful methods in predicting overall survival in gastric cancer patients in clinical practice. Larger prospective studies are needed to fully understand the effect of sarcopenia on prognosis in cancer patients and the effect of indices on prognosis.
Objectives: Gastric cancer patients often present with locally advanced or metastatic disease, and the aim of treatment is to provide palliation. Cachexia and sarcopenia are often seen in patients and this is one of the factors that determine the poor prognosis. The aim of our study was to investigate the prognostic values of inflammatory indices [modified Glasgow prognostic index [1] , prognostic index (PI), prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and neutrophil lymphocyte ratio (NLR)] in gastric cancer patients. Methods: The examinations of patients diagnosed with gastric cancer who applied to Bakırçay University Çiğli EAH Medical Oncology Outpatient Clinic between November 2020 and November 2023 were restrospectively screened and 81 patients with complete data were included in the study. PI, PNI, GNRI, mGPS and NLR markers were calculated using CRP-hemogram, albumin-hemogram, albumin-body weight, CRP-hemogram, hemogram tests alone, respectively. The median value of the NLR measurements of the patients was accepted as the NLR cut-off value. The calculation times of the indices were recorded. Other causes that would affect these parameters were ruled out. Statistical analysis was performed with SPSS (version 25.0) program. The mortality prediction values of the indices were recorded by calculating AUC by ROC analysis and compared with each other. Results:Median follow-up period of eighty-one patients The mean follow-up period was 43.48± 38.05 (median=33 weeks). During their follow-up between November 2020 and December 2023, 30 of 81 patients (37%) developed exitus. The mean age and body mass index [2] of the patients were 63.90± 11.23 years and 24.22± 4.79 kg/m2, respectively. The majority of the patients were between the ages of 60-85 (65.4%). Of the 81 patients, 51 were male. The median age was 66 years. Median survival time of patients was 83.85 weeks (77.12-90.58). According to the univariate analysis, the presence of metastasis, surgical history, GNRI, NLR, PI, mGPS, PNI, KI, and SII were found to have a significant effect on survival, whereas gender, age (below 66 vs. above), 8 BMI (below 24 vs. above) had no significant effect on survival. When the effect of laboratory values on univariate survival analysis was analyzed, WBC, neutrophil, and albumin values had a significant effect (p<.05) on survival. The effect of Hb, lymphocyte, and GFR was not significant. When albumin, WBC, neutrophils, and lymphocytes were included in the multivariate Cox regression model using the Backward LR method, the model was significant χ 2 (3) =21.394, p<.001. However, only albumin (threshold:<34<) had a significant effect on survival (B: 1.476, S.E: .47, p<.001, Exp(B)=4.374 (95% CI: 1.717, 11.145). Conclusions: In our study, mGPS, PNI and GNRI scores were found to be independent indicators of low survival in gastric cancer patients. mGPS, PNI and GNRI, which can be calculated in a very short time with only CRP, albumin, body weight and complete blood count data, can be cheap, useful and useful methods in predicting overall survival in gastric cancer patients in clinical practice. Larger prospective studies are needed to fully understand the effect of sarcopenia on prognosis in cancer patients and the effect of indices on prognosis.
Açıklama
Anahtar Kelimeler
Onkoloji, Oncology
