Pankreas kanserli hastalarda hematolojik parametrelerin (mean platelet volume, nötrofil/lenfosit oranı, trombosit/lenfosit oranı, eozinofil ve lenfosit sayısı) prognoz - tedavi takibinde kullanılabilirliklerinin araştırılması
Yükleniyor...
Dosyalar
Tarih
2015-09-03
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Değişik kanser tiplerinde inflamasyon belirteçlerinin prognostik önemi araştırılmıştır. Serolojik proinflamatuar belirteçler olan nötrofil-lenfosit oranı (NLO), trombosit-lenfosit oranı (TLO), ortalama trombosit hacmi(MPV), eozinofil sayısı ve lenfosit sayısı birçok kanser tipinde prognoz ve survi ile ilişkili bulunmuştur.Eozinofil ve MPV değerlerinin venöz tromboemboli ile ilişkili olduğunu gösteren çalışmalar mevcuttur.Bu çalışmada, proinflamatuar belirteçlerin inop pankreas kanserinde prognostik önemini ve tedavi takibinde kullanılabilirliğini araştırmayı amaçladık. Pankreas kanseri gibi tromboza yatkınlık oluşturduğu bilinen bir malignitede, venöz tromboemboli ile eozinofil ve MPV değerlerinin ilişkisini irdelemek istedik. Yöntem:Selçuk Üniversitesi Tıp Fakültesi Medikal Onkoloji bölümüne 1 Ocak 2010-3 Şubat 2015 tarihleri arasında başvurmuş , inop pankreas kanseri tanısı almış ve en az 3 kür kemoterapi almış 128 hastanın dosyaları retrospektif olarak tarandı ve hastaların kemoterapi öncesinde bakılmış olan hemogram parametreleri aynı sayıda sağlıklı kontrol grubunun hemogram parametreleri ile kıyaslandı.Hastalara pankreas kanseri tanısı konulduğu zaman(kemoterapi başlamadan önce) ve en az 3 kür kemoterapi aldıktan sonra bakılmış olan NLO,TLO,MPV ve lenfosit sayıları kıyaslandı. NLO için <3 ve ≥ 3 değerleri,TLO için <150 ve ≥ 150 değerleri,MPV için < 9 fL ve ≥ 9fL , Lenfosit için <1.5 x 103/mL ve ≥ 1.5 x 103/mL değerleri referans alındı. Medyan genel sağkalım Kaplan-Meier yöntemi kullanılarak değerlendirildi. NLO, TLO, MPV lenfosit değerlerinin bağımsız prognostik önemini belirlemek için, tek ve çok değişkenli Cox regresyon modelleri kullanıldı. Pankreas kanseri tanısı aldıktan sonra, tedavi veya izlem sürecinde venöz tromboemboli geçirmiş olan hastaların tromboz anı eozinofil değeri ve MPV değeri,aynı hastaların kemoterapi öncesi ve sonrası bakılmış olan eozinofil değeri ve MPV değeri ile kıyaslandı. Bulgular:Pankreas kanserli 128 hastanın sistemik inflamasyon markerları ve median survi arasındaki ilişki şöyle bulundu:KT öncesinde bakılan değerlerde; NLO <3 ve NLO ≥ 3 olanlarda median survi sırasıyla 17 ay ve 9.7 ay bulundu (p=0.013; hazard ratio (HR)= 1.686). TLO <150 ve ≥ 150 olanlarda median survi sırasıyla 17 ay ve 10.4 ay bulundu(p = 0.004; HR = 1.843). MPV <9 ve ≥ 9 olanlarda ise median survi sırasıyla 15.1 ay ve 13.6 ay bulundu(p= 0.202 ; HR= 1.309) . Lenfosit <1.5 x 103/mL ve ≥ 1.5 x 103/mL olanlarda median survi sırasıyla 10.4 ay ve 15.6 ay bulundu(p = 0.164; HR = 0.744). KT sonrasında bakılan değerlerde; NLO <3 ve NLO ≥ 3 olanlarda median survi sırasıyla 21.8 ay ve 10.4 ay bulundu (p=0.0001; HR= 2.166). TLO <150 ve ≥ 150 olanlarda median survi sırasıyla 20.6 ay ve 10.4 ay bulundu (p = 0.001; HR =2.075). MPV <9 ve ≥ 9 olanlarda ise median survi sırasıyla 18.3 ay ve 11.4 ay bulundu(p= 0.01 ; HR = 1.710) . Lenfosit <1.5 x 103/mL ve ≥ 1.5 x 103/mL olanlarda median survi sırasıyla 11.4 ay ve 20.6 ay bulundu ( p = 0.012 ; HR = 0.577). Kemoterapi öncesinde bakılmış olan eozinofil değerinin pankreas kanseri progrese olanlar ile regrese veya stabil hastalığı olanlar arasında anlamlı farklılığa sahip olmadığı görüldü (p=0.054) Tromboz anında bakılmış olan eozinofil ve MPV değerleri,aynı hastaların KT öncesi ve sonrasında bakılmış eozinofil değerlerinden istatiksel açıdan anlamlı şekilde yüksek bulundu (0,33 ± 0,32 ve 10,59 ± 1,77 - 0,16 ± 0,27 ve 8,73 ± 1,51- 0,14 ± 0,17 ve 8,89 ± 1,63 p=0.0001).Kontrol grubu ile hastaların KT öncesi hemogram parametreleri kıyaslandığında ise NLO, MPV değerleri kontrol grubu değerlerine göre anlamlı şekilde yüksek,eozinofil ve lenfosit değerleri ise anlamlı şekilde düşük bulundu( NLO: 3,5 ± 3,34 - 1,93 ± 0,72 p=0.0001, MPV: 8,79 ± 1,57 - 7,05 ± 1,02 p=0.0001, Eozinofil: 0,18 ± 0,17 - 0,2 ± 0,12 p=0.038, Lenfosit: 1,8 ± 0,84 - 2,4 ±0,8 p=0.0001).Hasta grubunun TLO kontrol grubuna göre daha yüksek bulunmasına rağmen arada istatiksel açıdan önemli farklılık saptanmadı ( 177 ± 111 - 136 ± 49 p=0.096). Sonuç: Bizim bulgularımıza göre kemoterapi öncesinde ve sonrasında bakılmış olan NLO, TLO ve Lenfosit değeri pankreas kanserinin prognozunu ve survisini belirlemede,tedavi takibi ve izlemde yararlı olabilecek parametrelerdendir. Lenfosit sayısı survi ilişkisi sadece kemoterapi öncesi dönemde anlamlı bulunmamış,ancak aynı dönemde bakıldığında prognozla ilişkili olduğu belirlenmiştir. MPV değerleri kemoterapi öncesinde değil fakat sadece kemoterapi sonrasında bakıldıklarında pankreas kanseri tedavi takibi ve izleminde,prognoz ve survisini belirlemede yararlı olabilirler. Eozinofil değerinin, kemoterapi öncesi ve sonrasında pankreas kanserinin prognoz ve survi tayininde yaralı olabilecek bir markır olmadığı saptanmıştır. Pankreas kanserli hastalarda gelişen venöz tromboemboli hadiselerinde, eozinofil ve MPV değerlerinin önemli markırlar olabileceği kanısına varılmıştır.
Background: The prognostic significance of various systemic inflammation-based markers has been explored in different cancers. Serological proinflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR),mean platelet volume (MPV), lymphocyte and eosinophil count have been associated with prognosis and survival for many different types of cancer. Studies have proven that eosinophil count and MPV values are associated with venous tromboembolism. In a malignancies such as pancreatic cancer it is known to predispose to thrombosis, we aimed to investigate the relationship between eosinophil count and MPV values with venous thromboembolism in pancreatic cancer patients. This study determined the prognostic value of these markers in patients with in-op pancreatic adenocarcinoma. These markers can be used to assist with decision-making in oncology clinics. Aim: The aim of this study was to investigate the prognostic significance of systemic inflammation-based factors: neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) , mean platelet volume (MPV),eosinophil and lymphocyte count in patients with advanced pancreatic cancer, investigate the relationship between eosinophil count and MPV values with venous thromboembolism in this group. Methods: Data were collected retrospectively for advanced 128 inoperable pancreatic cancer patients treated (received at least 3 cycles of chemotherapy) between 1 January 2010 and 03 February 2015 at the Selcuk University Medical School Hospital,Medical Oncology Department and the hemogram parameters of the patients prior to chemotherapy were compared with the same number of healthy controls. Once diagnosed with pancreatic cancer (before starting chemotherapy) and after the patients received at least 3 cycles of chemotherapy, which was analyzed and compared NLR ,PLR,MPV and lymphocyte count. The ratios were dichotomised as <3 versus ≥3 for NLR ,<150 versus ≥150 for PLR, <9 fL versus ≥ 9 fL for MPV and <1.5 x 103/mL versus ≥ 1.5 x 103/mL for lymphocyte count. Median overall survival was assessed using the Kaplan–Meier method.To evaluate the independent prognostic significance of the NLR, PLR, MPV and lymphocyte count,univariate and multivariate Cox regression models were applied. After receiving the diagnosis of pancreatic cancer treatment or follow-up period of patients who have had venous thromboembolism,eosinophil count and MPV values of during trombosis were compared with the same patients before and after chemotherapy values of eosinophils and MPV . Results: Data were evaluable for 128 patients. Median survivals based on the inflammation-based prognostic markers evaluated were: Looking at the data before chemotherapy; NLR <3 versus ≥3 = 17 months versus 9.7 months respectively (p=0.013; hazard ratio (HR)= 1.686). PLR <150 versus ≥150 = 17 months versus 10.4 months respectively (p = 0.004; HR = 1.843). MPV <9 versus ≥9=15.1 months versus 13.6 months respectively (p= 0.202 HR= 1.309). Lymphocyte count <1.5 x 103/mL versus ≥ 1.5 x 103/mL =10.4 months versus 15.6 months respectively(p = 0.164; HR= 0.744). Looking at the data after chemotherapy; NLR <3 versus ≥3 = 21.8 months versus 10.4 months respectively(p=0.0001; HR = 2.166). PLR <150 versus ≥150 = 20.6 months versus 10.4 months respectively (p = 0.001; HR =2.075). MPV <9 versus ≥9=18.3 months versus 11.4 months respectively (p= 0.01 ; HR= 1.710). Lymphocyte count <1.5 x 103/mL versus ≥ 1.5 x 103/mL =11.4 months versus 20.6 months respectively ( p = 0.012 ; HR = 0.577). Eosinophil values were checked before chemotherapy,there were no significant differences between the groups of patients with pancreatic cancer progression and regression(p=0.054). Patients who have had venous thromboembolism, eosinophil and MPV values of during trombosis were statistically significantly higher than the same patients before and after chemotherapy values of eosinophils and MPV (0,33 ± 0,32 and 10,59 ± 1,77 - 0,16 ± 0,27 and 8,73 ± 1,51 - 0,14 ± 0,17 and 8,89 ± 1,63 p=0.0001). Hemogram parameters of the patients before starting to chemotherapy were compared with the healthy controls hemogram parameters. NLR and MPV values were significantly higher in pancreatic cancer patients compared to the control group, but eosinophil and lymphocyte counts were significantly lower than control group ( NLR: 3,5 ± 3,34 versus 1,93 ± 0,72 p=0.0001, MPV: 8,79 ± 1,57 versus 7,05 ± 1,02 p=0.0001, Eosinophil: 0,18 ± 0,17 versus 0,2 ± 0,12 p=0.038, Lymphocyte: 1,8 ± 0,84 - 2,4 ±0,8 p=0.0001). Although pancreatic cancer patients PLR values were higher than control group there was no statistically significant difference between the two groups PLR values( 177 ± 111 versus 136 ± 49 p=0.096). Conclusions: Our findings suggest that before and after chemotherapy, the NLR , PLR values and Lymphocyte count determination of prognosis and survival of pancreatic cancer, one of the parameters that may be useful for monitoring treatment and follow-up. There was no significant relationship between the number of lymphocyte and survival in the period just prior to chemotherapy, but was determined to be associated with prognosis in the same period. MPV values not before but only after chemotherapy may be useful for monitoring treatment and follow-up, determination of prognosis and survival of pancreatic cancer. Eosinophil count is not a significant marker before and after chemotherapy, determination of pancreatic cancer prognosis and survival. Finally MPV and eosinophil values may be important markers in pancreatic cancer patients with venous thromboembolic events.
Background: The prognostic significance of various systemic inflammation-based markers has been explored in different cancers. Serological proinflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR),mean platelet volume (MPV), lymphocyte and eosinophil count have been associated with prognosis and survival for many different types of cancer. Studies have proven that eosinophil count and MPV values are associated with venous tromboembolism. In a malignancies such as pancreatic cancer it is known to predispose to thrombosis, we aimed to investigate the relationship between eosinophil count and MPV values with venous thromboembolism in pancreatic cancer patients. This study determined the prognostic value of these markers in patients with in-op pancreatic adenocarcinoma. These markers can be used to assist with decision-making in oncology clinics. Aim: The aim of this study was to investigate the prognostic significance of systemic inflammation-based factors: neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) , mean platelet volume (MPV),eosinophil and lymphocyte count in patients with advanced pancreatic cancer, investigate the relationship between eosinophil count and MPV values with venous thromboembolism in this group. Methods: Data were collected retrospectively for advanced 128 inoperable pancreatic cancer patients treated (received at least 3 cycles of chemotherapy) between 1 January 2010 and 03 February 2015 at the Selcuk University Medical School Hospital,Medical Oncology Department and the hemogram parameters of the patients prior to chemotherapy were compared with the same number of healthy controls. Once diagnosed with pancreatic cancer (before starting chemotherapy) and after the patients received at least 3 cycles of chemotherapy, which was analyzed and compared NLR ,PLR,MPV and lymphocyte count. The ratios were dichotomised as <3 versus ≥3 for NLR ,<150 versus ≥150 for PLR, <9 fL versus ≥ 9 fL for MPV and <1.5 x 103/mL versus ≥ 1.5 x 103/mL for lymphocyte count. Median overall survival was assessed using the Kaplan–Meier method.To evaluate the independent prognostic significance of the NLR, PLR, MPV and lymphocyte count,univariate and multivariate Cox regression models were applied. After receiving the diagnosis of pancreatic cancer treatment or follow-up period of patients who have had venous thromboembolism,eosinophil count and MPV values of during trombosis were compared with the same patients before and after chemotherapy values of eosinophils and MPV . Results: Data were evaluable for 128 patients. Median survivals based on the inflammation-based prognostic markers evaluated were: Looking at the data before chemotherapy; NLR <3 versus ≥3 = 17 months versus 9.7 months respectively (p=0.013; hazard ratio (HR)= 1.686). PLR <150 versus ≥150 = 17 months versus 10.4 months respectively (p = 0.004; HR = 1.843). MPV <9 versus ≥9=15.1 months versus 13.6 months respectively (p= 0.202 HR= 1.309). Lymphocyte count <1.5 x 103/mL versus ≥ 1.5 x 103/mL =10.4 months versus 15.6 months respectively(p = 0.164; HR= 0.744). Looking at the data after chemotherapy; NLR <3 versus ≥3 = 21.8 months versus 10.4 months respectively(p=0.0001; HR = 2.166). PLR <150 versus ≥150 = 20.6 months versus 10.4 months respectively (p = 0.001; HR =2.075). MPV <9 versus ≥9=18.3 months versus 11.4 months respectively (p= 0.01 ; HR= 1.710). Lymphocyte count <1.5 x 103/mL versus ≥ 1.5 x 103/mL =11.4 months versus 20.6 months respectively ( p = 0.012 ; HR = 0.577). Eosinophil values were checked before chemotherapy,there were no significant differences between the groups of patients with pancreatic cancer progression and regression(p=0.054). Patients who have had venous thromboembolism, eosinophil and MPV values of during trombosis were statistically significantly higher than the same patients before and after chemotherapy values of eosinophils and MPV (0,33 ± 0,32 and 10,59 ± 1,77 - 0,16 ± 0,27 and 8,73 ± 1,51 - 0,14 ± 0,17 and 8,89 ± 1,63 p=0.0001). Hemogram parameters of the patients before starting to chemotherapy were compared with the healthy controls hemogram parameters. NLR and MPV values were significantly higher in pancreatic cancer patients compared to the control group, but eosinophil and lymphocyte counts were significantly lower than control group ( NLR: 3,5 ± 3,34 versus 1,93 ± 0,72 p=0.0001, MPV: 8,79 ± 1,57 versus 7,05 ± 1,02 p=0.0001, Eosinophil: 0,18 ± 0,17 versus 0,2 ± 0,12 p=0.038, Lymphocyte: 1,8 ± 0,84 - 2,4 ±0,8 p=0.0001). Although pancreatic cancer patients PLR values were higher than control group there was no statistically significant difference between the two groups PLR values( 177 ± 111 versus 136 ± 49 p=0.096). Conclusions: Our findings suggest that before and after chemotherapy, the NLR , PLR values and Lymphocyte count determination of prognosis and survival of pancreatic cancer, one of the parameters that may be useful for monitoring treatment and follow-up. There was no significant relationship between the number of lymphocyte and survival in the period just prior to chemotherapy, but was determined to be associated with prognosis in the same period. MPV values not before but only after chemotherapy may be useful for monitoring treatment and follow-up, determination of prognosis and survival of pancreatic cancer. Eosinophil count is not a significant marker before and after chemotherapy, determination of pancreatic cancer prognosis and survival. Finally MPV and eosinophil values may be important markers in pancreatic cancer patients with venous thromboembolic events.
Açıklama
Anahtar Kelimeler
Antineoplastik ajanlar, Antineoplastic agents, Biyobelirteçler, Biomarkers, Neoplazmlar, Neoplasms, Pankreas hastalıkları, Pancreatic diseases, Pankreas neoplazmları, Pancreatic neoplasms, Prognoz, Prognosis, Tromboz, Thrombosis, İnflamasyon, Inflammation
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çölkesen, F. (2015). Pankreas kanserli hastalarda hematolojik parametrelerin (mean platelet volume, nötrofil/lenfosit oranı, trombosit/lenfosit oranı, eozinofil ve lenfosit sayısı) prognoz - tedavi takibinde kullanılabilirliklerinin araştırılması. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
