Öz
Amaç: Ege Üniversitesi Hastanesinde 1992-2017 arası kanser tanı ve tedavisi yapılan 3791
karaciğer, safra kesesi ve safra yolu kanseri hastasının epidemiyolojik ve sağ kalım özelliklerinin
karşılaştırılmasıdır.
Gereç ve Yöntem: Ege Üniversitesi Kanserle Savaş Araştırma ve Uygulama Merkezi tarafından
toplanan hepatosellüler kanser, intrahepatik ve ekstrahepatik kolanjiosellüler karsinom, safra kesesi ve
ampulla Vater tümörleri verileri DSÖ ve SEER sistemleri temelinde gruplanarak analizler yapılmıştır.
Tümörlerin yaşam süreleri, farklı evrelerdeki yaşam süreleri ve yaşam süresi farkları, cinsiyet, yaş ve
uygulanan tedavilerin yaşam süresi ile ilişkileri araştırılmıştır.
Bulgular: 3791 hastadan 1832 hasta hepatosellüler kanser (HSK), 440 hasta intrahepatik
kolanjiokarsinoma, 447 hasta ekstrahepatik kolanjiokarsinoma, 540 hasta safra kesesi kanseri ve 532
hasta ampulla Vater kanseri tanısı almıştı. HSK, kolanjiokarsinomlar ve ampulla Vater kanseri
erkeklerde, safra kesesi kanseri ise kadın olgularda daha fazla idi. TNM sınıflanmasına göre tüm
gruplarda hastaların daha çok ileri evrede olduğu görülmüştür ve en fazla ileri evre hasta olan grup
safra kesesi kanserleriydi.
Ortalama yaşam süreleri HSK için 15 ay, intrahepatik kolanjiokarsinom için sekiz ay, ekstrahepatik
kolanjiokarsinom için 10 ay, safra kesesi kanseri için sekiz ay ve ampulla Vater kanseri için 19 ay
bulunmuştur. Tedavi modalitelerine göre yaşam süresine bakıldığında tüm kanser gruplarında cerrahi
tedavi uygulanan hastalarda yaşam süresi daha uzundu. Radyoterapi (RT) uygulamasının sadece
safra kesesi kanseri olan hastalarda hayatta kalma üzerine olumlu etkisi bulunmuştur. Kemoterapi
(KT) verilmesi intra/ekstrahepatik kolanjiokarsinom ve safra kesesi kanserlerinde hayatta kalmada
uzama ile ilişkili bulunurken, HSK ve ampulla Vater kanseri olan hastalarda KT verilen ve verilmeyen
hastalar arasında yaşam süresi açısından fark bulunmamıştır.
Sonuç: Bu seri 3791 hasta ile hepatobiliyer kanserlerle ilgili Türkiye’de yayınlanmış olan en geniş
seridir. Hastalar genelde ileri evrede tanı almaktadır. Cerrahi tedavi tüm gruplarda, RT ve KT ise bazı
gruplarda yaşam süresinde uzama ile ilişkilidir.
Anahtar Kelimeler
Hepatobiliyer kanser epidemiyoloji insidans mortalite genel sağ kalım.
Kaynakça
- Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S, Ahmed M, et al. The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015. JAMA Oncol. 2017; 3: 1683-91.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424.
- El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology. 2014; 60: 1767-75.
- Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61: 69-90.
- Ryerson AB, Eheman CR, Altekruse SF, et al. Annual Report to the Nation on the Status of Cancer, 1975- 2012, featuring the increasing incidence of liver cancer. Cancer. 2016; 122: 1312-37.
- Bosetti C, Levi F, Boffetta P, Lucchini F, Negri E, La Vecchia C. Trends in mortality from hepatocellular carcinoma in Europe, 1980-2004. Hepatology. 2008; 48: 137-45.
- Naugler WE, Sakurai T, Kim S, Maeda S, Kim K, Elsharkawy AM, Karin M. Gender disparity in liver cancer due to sex differences in MyD88-dependent IL-6 production. Science. 2007; 317: 121-4.
- Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis. 1994; 14: 109-14.
- Khan SA, Emadossadaty S, Ladep NG, Thomas HC, Elliott P, Taylor-Robinson SD, Toledano MB. Rising trends in cholangiocarcinoma: is the ICD classification system misleading us? J Hepatol. 2012; 56: 848-54.
- Jepsen P, Vilstrup H, Tarone RE, Friis S, Sørensen HT. Incidence rates of intra- and extrahepatic cholangiocarcinomas in Denmark from 1978 through 2002. J Natl Cancer Inst. 2007; 99: 895-7.
- Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006; 118: 1591-602.
- Altekruse SF, Devesa SS, Dickie LA, McGlynn KA, Kleiner DE. Histological classification of liver and intrahepatic bile duct cancers in SEER registries. J Registry Manag 2011; 38: 201-5.
- Dorak MT, Karpuzoglu E. Gender differences in cancer susceptibility: an inadequately addressed issue. Front Genet 2012; 3: 268.
- Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet. 1981; 2: 1129-33.
- Colombo M, de Franchis R, Del Ninno E, et al. Hepatocellular carcinoma in Italian patients with cirrhosis. N Engl J Med. 1991; 325: 675-80.
- Tsukuma H, Hiyama T, Tanaka S, et al. Risk factors for hepatocellular carcinoma among patients with chronic liver disease. N Engl J Med. 1993; 328: 1797-801.
- Bertuccio P, Turati F, Carioli G, et al. Global trends and predictions in hepatocellular carcinoma mortality. J Hepatol 2017; 67: 302-9.
- Liu Z, Jiang Y, Yuan H, et al. The trends in incidence of primary liver cancer caused by specific etiologies: Results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention. J Hepatol 2019; 70: 674-83.
- Altekruse SF, McGlynn KA, Dickie LA, Kleiner DE. Hepatocellular carcinoma confirmation, treatment, and survival in Surveillance, Epidemiology, and End Results registries, 1992-2008. Hepatology 2012; 55: 476–82.
- Somboon K, Siramolpiwat S, Vilaichone RK. Epidemiology and survival of hepatocellular carcinoma in the central region of Thailand. Asian Pac J Cancer Prev. 2014; 15: 3567-70.
- Jemal A, et al: Cancer statistics, 2003. CA Cancer J Clin 2003; 53: 5–26.
- Razumilava N, Lazaridis KN, Gores GJ. Cholangiocarcinoma. In: Sanyal AJ (ed). Zakim and Boyer’s Hepatology: A Textbook of Liver Disease, 7th ed. Philadelphia, PA : Elsevier, 2018; 693-707.
- Chang DK, Jamieson NB, Johns AL, et al. Histomolecular phenotypes and outcome in adenocarcinoma of the ampulla of vater. J Clin Oncol 2013; 31: 1348-56.
Öz
Aim: The aim of this study was to compare the epidemiological and survival features of 3791 liver,
gallbladder, and biliary tract cancer patients who were diagnosed and treated between 1992 and 2017
at Ege University Hospital.
Materials and Methods: The database of Ege University Cancer Research for liver, gallbladder, and
biliary tract cancers were grouped and analyzed based on DSO and SEER systems. Survival time for
each tumor, survival times and survival differences for different stages of tumors, and the associations
between survival times and the sex, age, and treatment modalities were investigated.
Results: Among 3791 cases, 1832 were hepatocellular carcinoma (HCC), 440 were intrahepatic
cholangiocarcinoma, 447 were extrahepatic cholangiocarcinoma, 540 were gallbladder cancer, and
532 were ampullary cancer. HCC, cholangiocarcinomas, and ampullary cancer were more common in
men; gallbladder cancers were more common in women. According to TNM classification, the patients
were in advanced stages in all groups and the most advanced stage patients were in gallbladder
cancer group. Ortalama survival times were 15 months for HCC, 8 months for intrahepatic
cholangiocarcinoma, 10 months for extrahepatic cholangiocarcinoma, 8 months for gallbladder cancer,
and 19 months for ampullary cancer. When survival was evaluated according to treatment modalities,
survival was longer in patients treated with surgery in all cancer groups. Radiotherapy (RT) had a
positive effect on survival only in patients with gallbladder cancer. Whereas chemotherapy (CT) was
associated with survival prolongation in intra/extrahepatic cholangiocarcinoma and gallbladder
cancers, there was no survival difference favoring CT administration in patients with HCC and
ampullary cancer.
Conclusion: This series is the largest of hepatobiliary cancers that was published in Turkey. Patients
are usually diagnosed at an advanced stage. Surgical treatment is associated with prolongation of
survival in all groups and RT and CT in some groups.
Anahtar Kelimeler
Hepatobiliary cancer epidemiology incidence mortality overall survival.
Kaynakça
- Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S, Ahmed M, et al. The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015. JAMA Oncol. 2017; 3: 1683-91.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424.
- El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology. 2014; 60: 1767-75.
- Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61: 69-90.
- Ryerson AB, Eheman CR, Altekruse SF, et al. Annual Report to the Nation on the Status of Cancer, 1975- 2012, featuring the increasing incidence of liver cancer. Cancer. 2016; 122: 1312-37.
- Bosetti C, Levi F, Boffetta P, Lucchini F, Negri E, La Vecchia C. Trends in mortality from hepatocellular carcinoma in Europe, 1980-2004. Hepatology. 2008; 48: 137-45.
- Naugler WE, Sakurai T, Kim S, Maeda S, Kim K, Elsharkawy AM, Karin M. Gender disparity in liver cancer due to sex differences in MyD88-dependent IL-6 production. Science. 2007; 317: 121-4.
- Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis. 1994; 14: 109-14.
- Khan SA, Emadossadaty S, Ladep NG, Thomas HC, Elliott P, Taylor-Robinson SD, Toledano MB. Rising trends in cholangiocarcinoma: is the ICD classification system misleading us? J Hepatol. 2012; 56: 848-54.
- Jepsen P, Vilstrup H, Tarone RE, Friis S, Sørensen HT. Incidence rates of intra- and extrahepatic cholangiocarcinomas in Denmark from 1978 through 2002. J Natl Cancer Inst. 2007; 99: 895-7.
- Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006; 118: 1591-602.
- Altekruse SF, Devesa SS, Dickie LA, McGlynn KA, Kleiner DE. Histological classification of liver and intrahepatic bile duct cancers in SEER registries. J Registry Manag 2011; 38: 201-5.
- Dorak MT, Karpuzoglu E. Gender differences in cancer susceptibility: an inadequately addressed issue. Front Genet 2012; 3: 268.
- Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet. 1981; 2: 1129-33.
- Colombo M, de Franchis R, Del Ninno E, et al. Hepatocellular carcinoma in Italian patients with cirrhosis. N Engl J Med. 1991; 325: 675-80.
- Tsukuma H, Hiyama T, Tanaka S, et al. Risk factors for hepatocellular carcinoma among patients with chronic liver disease. N Engl J Med. 1993; 328: 1797-801.
- Bertuccio P, Turati F, Carioli G, et al. Global trends and predictions in hepatocellular carcinoma mortality. J Hepatol 2017; 67: 302-9.
- Liu Z, Jiang Y, Yuan H, et al. The trends in incidence of primary liver cancer caused by specific etiologies: Results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention. J Hepatol 2019; 70: 674-83.
- Altekruse SF, McGlynn KA, Dickie LA, Kleiner DE. Hepatocellular carcinoma confirmation, treatment, and survival in Surveillance, Epidemiology, and End Results registries, 1992-2008. Hepatology 2012; 55: 476–82.
- Somboon K, Siramolpiwat S, Vilaichone RK. Epidemiology and survival of hepatocellular carcinoma in the central region of Thailand. Asian Pac J Cancer Prev. 2014; 15: 3567-70.
- Jemal A, et al: Cancer statistics, 2003. CA Cancer J Clin 2003; 53: 5–26.
- Razumilava N, Lazaridis KN, Gores GJ. Cholangiocarcinoma. In: Sanyal AJ (ed). Zakim and Boyer’s Hepatology: A Textbook of Liver Disease, 7th ed. Philadelphia, PA : Elsevier, 2018; 693-707.
- Chang DK, Jamieson NB, Johns AL, et al. Histomolecular phenotypes and outcome in adenocarcinoma of the ampulla of vater. J Clin Oncol 2013; 31: 1348-56.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Ek |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2019 |
| Gönderilme Tarihi | 15 Şubat 2019 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 58 Özel Sayı: 2 (Onkoloji) |
