Kemik metastazlı solid tümörlü hastalarda metastazın bölgesel dağılımı
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Tarih
2024
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kanser vakalarının toplumda görülme sıklığı artması ile birlikte kansere bağlı gelişen metastazlarda da artış görülmektedir. Kemik metastazları da ortopedi pratiğinde gün geçtikçe artan, mortalite ve morbiditeye sebep olan metastazlardan biridir. Bu çalışmada kemik metastaz bölgelerini, metastaza bağlı iskelet ile ilişkili olayları (SRE) ve bunların mortalite ile ilişkileri incelenecektir.
Yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Hastanesi hasta arşivinden 2012 Ocak ile 2022 Aralık tarihleri arasında Pet-BT çekilen 13.047 hastanın demografik bilgileri, Pet-BT raporları, patoloji raporları, iskelet ile ilişkili olaylar, metastaz bölgeleri, tanıdan metastaza kadar geçen süre ve ölüm zamanı hastane otomasyon kayıt sisteminden retrospektif olarak tarandı. Çalışmamıza dahil edilme kriterleri; ilk kemik metastazını belirtilen tarama zamanı içinde yapan, 18-99 yaş arası kemik metastazı olan solid tümörlü hastalar olarak belirlendi. Çalışmanın dışlama kriterleri; solid tümör dışı maligniteler, primer kemik tümörleri, 18 yaş altı çocukluk çağı kanserler ve eksik veri kaydı olan hastalar olarak belirlendi. Çalışma kriterlerini karşılayan 810 hasta çalışmaya dahil edildi. Sağkalım eğrileri arasındaki fark Kaplan-Meier yöntemi kullanılarak karşılaştırıldı.
Bulgular: Hastalarda kemik metastazı gelişme sıklığı akciğer, meme, prostat, genitoüriner gastrointestinal, primeri bilinmeyen ve diğer kanserlerde sırayla %8,8/ %12,5/ %29,1/ %5,1/ %3,3/ %3,2/ %2,5 şeklindeydi. Çalışmaya alınan 810 hastanın 470 i (%58.0) erkek, 340 ı (%42.0) kadındı. Hastaların yaş ortalaması 67,05 ti (±12,75). Multipl kemik metastazı 649 (%80,1) hastada bulundu. Kemik metastazı yapan kanser hastalarına bakıldığında birinci metastazın en sık vertebraya olduğu ve vertebra içinde en sık torakal vertebraya (%65,5) olduğu, ikinci kemik metastazın en sık skapulaya (%33,1) olduğu, üçüncü kemik metastazın en sık yaygın (birden fazla kemik) (%29,8) olduğu bulundu. Hastaların %45,8 inde metastaza bağlı SRE görüldü. Tanıdan 1.metastaza kadar geçen süre ortalama 13,4±23,2 ay, ikinci metastaza kadar geçen süre ortalama 33,8±30,6 ay, üçüncü metastaza kadar geçen süre ortalama 49,3±33,6 aydı. Akciğer, primeri bilinmeyen kanserler ve diğer olarak gruplandırılan kanserlerde kemik metastaz sonrası hastalığın çok hızlı ilerlediği ve medyan hayatta kalma süresinin 6 aydan kısa olduğu görüldü. Tek kemik metastazı, multipl kemik metastazıyla kıyaslandığında tek kemik metastazı olan hastalarda hayatta kalma süresi anlamlı şekilde uzundu. (p <0,05). Multipl kemik metastazı tutulum yerleri kendi arasında karşılaştırıldığında vertebra tutulumu, yaygın tutuluma göre anlamlı şekilde daha uzun yaşam süresi bulundu (p<0,001). Akciğer, meme ve gastrointestinal kanserlerde kemik metastaz yerleri ile metastaz sonrası hayatta kalma süresi arasında anlamlı fark bulundu (p<0,05).
Sonuç: Çalışmamız, solid tümörlerin %6,2 kemik metastazı yaptığını ve en sık vertebraya metastaz olduğunu, ikincil metastazın en sık skapulaya, üçüncül metastazın en sık yaygın metastaz olarak görüldüğünü göstermiştir. Akciğer kanseri, primeri bilinmeyen kanser ve diğer kanserlerde kemik metastaz sonrası hayatta kalma süresinin 6 aydan kısa olduğu gösterilmiştir. Çalışmamız, bildiğimiz kadarıyla literatürde daha önce tanımlanmayan solid tümörlerdeki kemik metastaz sıklığını ve ikincil ile üçüncül kemik metastaz bölgelerini tanımlayan ilk çalışma olmuştur.
Abstract: The rising incidence of cancer cases has led to a concomitant increase in bone metastases, posing a significant public health challenge. This study aimed to investigate the distribution of bone metastases, skeletal events associated with metastases, and their association with mortality. Methods: The study included data from 13,047 patients who underwent PET-CT scans at Necmettin Erbakan University Faculty of Medicine Hospital between 2012 and 2022. Patients included in the study were those with solid tumors diagnosed with their first bone metastasis during the screening period and were between 18 and 99 years old. Patients with solid tumors without bone metastases, primary bone tumors, childhood cancers, and incomplete data records were excluded. Results: The frequency of bone metastasis development in patients was 8.8% / 12.5% / 29.1% / 5.1% / 3.3% / 3%, respectively, in lung, breast, prostate, genitourinary gastrointestinal, unknown primary and other cancers, respectively. It was 2/ 2.5%. Of the 810 patients included in the study, 470 (58.0%) were men and 340 (42.0%) were women. The average age of the patients was 67.05 (±12.75). Multiple bone metastases were found in 649 (80.1%) patients. When we look at cancer patients with bone metastasis, the first metastasis is most frequently to the vertebra and within the vertebra, the most common is to the thoracic vertebra (65.5%), the second bone metastasis is most frequently to the scapula (33.1%), and the third bone metastasis is the most common (multiple). bone) (29.8%). Skeletal-related events due to metastasis occurred in 45.8% of the patients. The average time from diagnosis to the first metastasis was 13.4±23.2 months, the average time to the second metastasis was 33.8±30.6 months, and the average time to the third metastasis was 49.3±33.6 months. It was observed that the disease progressed very rapidly after bone metastasis in cancers grouped as lung, cancers of unknown primary, and other, and the median survival time was less than 6 months. Survival time after metastasis was significantly longer in single bone metastases than in multiple bone metastases. (p <0.05). When multiple bone metastasis involvement sites were compared among themselves, a significantly longer survival time was found for vertebral involvement than for widespread involvement (p<0.001). A significant difference was found between bone metastasis sites and post-metastasis survival time in lung, breast and gastrointestinal cancers (p<0.05). Conclusion: Our study showed that the most common site of cancer involvement is the vertebra, secondary metastasis is most common in the scapula, and tertiary metastasis is most common. In addition, it has been found at times from diagnosis to primary, secondary and tertiary metastases. Relationships between the site of bone involvement and mortality have been determined. In the light of this information, it is thought that delaying metastasis in patients with bone metastases and developing diagnostic and treatment practices accordingly will increase the survival time in cancer patients.
Abstract: The rising incidence of cancer cases has led to a concomitant increase in bone metastases, posing a significant public health challenge. This study aimed to investigate the distribution of bone metastases, skeletal events associated with metastases, and their association with mortality. Methods: The study included data from 13,047 patients who underwent PET-CT scans at Necmettin Erbakan University Faculty of Medicine Hospital between 2012 and 2022. Patients included in the study were those with solid tumors diagnosed with their first bone metastasis during the screening period and were between 18 and 99 years old. Patients with solid tumors without bone metastases, primary bone tumors, childhood cancers, and incomplete data records were excluded. Results: The frequency of bone metastasis development in patients was 8.8% / 12.5% / 29.1% / 5.1% / 3.3% / 3%, respectively, in lung, breast, prostate, genitourinary gastrointestinal, unknown primary and other cancers, respectively. It was 2/ 2.5%. Of the 810 patients included in the study, 470 (58.0%) were men and 340 (42.0%) were women. The average age of the patients was 67.05 (±12.75). Multiple bone metastases were found in 649 (80.1%) patients. When we look at cancer patients with bone metastasis, the first metastasis is most frequently to the vertebra and within the vertebra, the most common is to the thoracic vertebra (65.5%), the second bone metastasis is most frequently to the scapula (33.1%), and the third bone metastasis is the most common (multiple). bone) (29.8%). Skeletal-related events due to metastasis occurred in 45.8% of the patients. The average time from diagnosis to the first metastasis was 13.4±23.2 months, the average time to the second metastasis was 33.8±30.6 months, and the average time to the third metastasis was 49.3±33.6 months. It was observed that the disease progressed very rapidly after bone metastasis in cancers grouped as lung, cancers of unknown primary, and other, and the median survival time was less than 6 months. Survival time after metastasis was significantly longer in single bone metastases than in multiple bone metastases. (p <0.05). When multiple bone metastasis involvement sites were compared among themselves, a significantly longer survival time was found for vertebral involvement than for widespread involvement (p<0.001). A significant difference was found between bone metastasis sites and post-metastasis survival time in lung, breast and gastrointestinal cancers (p<0.05). Conclusion: Our study showed that the most common site of cancer involvement is the vertebra, secondary metastasis is most common in the scapula, and tertiary metastasis is most common. In addition, it has been found at times from diagnosis to primary, secondary and tertiary metastases. Relationships between the site of bone involvement and mortality have been determined. In the light of this information, it is thought that delaying metastasis in patients with bone metastases and developing diagnostic and treatment practices accordingly will increase the survival time in cancer patients.
Açıklama
Anahtar Kelimeler
Kemik metastazı, Bone metastasis, iskelet ilişkili olaylar, skeletal-related events, mortalite, mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Tahak, F. (2024). Kemik metastazlı solid tümörlü hastalarda metastazın bölgesel dağılımı. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
