Publication: Endometrium Kanseri Olgularında Mikrosatellit İnstabilite'nin Prognostik Faktörlerle İlişkisi
Abstract
Giriş ve Amaç: Endometrium kanseri gelişmiş ülkelerde en sık görülen jinekolojik malignitedir.Çalışmamızda hastanemize başvuran endometrium kanserli olgularda immünhistokimyasal yöntemlerle mikrosatellit instabilite(MSI) çalışılarak hastalığın prognozuna ve tedavi cevabına etkisinin incelenmesi amaçlandı. Gereç ve Yöntem: 2018 ile 2022 yılları arasında endometrium kanseri tanısı alan 204 hasta çalışmaya dahil edildi. İmmünhistokimyasal yöntemle MLH1, MSH2, MSH6 ve PMS2 belirteçleri kullanılarak mikrosatellit instabilite araştırıldı. En az bir lokusta instabilite saptanan hastalar MSI, instabilite saptanmayan hastalar MSS (mikrosatellit stabil) olarak kabul edildi. Bu iki grup prognostik faktörler ve kemoterapi yanıtı açısından karşılaştırıldı. Bulgular: Çalışmamızda endometrium kanseri tanısı alan 204 hasta incelendiğinde, ortalama yaş 61.46 (±10.48) olarak izlendi. Hastaların 55'i (%26.96) MSI, 149'u (%73.04) MSS olarak saptandı. En sık görülen ekspresyon kaybı mlh-1/pms-2 olarak izlendi. MSI saptanan hastalarda tanı anında evrenin MSS hastalara göre daha yüksek olduğu istatistiksel olarak anlamlı bulundu (p<0.001). Hastaların grade, myometrial invazyon, lenfovasküler invazyon ve lenf nodu metastazları değerlendirildiğinde, MSI hastalarda bu parametreler MSS hastalara göre istatistiksel olarak anlamlı şekilde yüksek bulundu (p<0.001). Kemoterapi alan 11 MSS hastanın %72.7'sinde tam yanıt, %9.1'inde parsiyel yanıt, %9.1'inde stabil hastalık, %9.1'inde progresyon görüldü. Kemoterapi alan 13 MSI hastanın %7.7'sinde tam yanıt, %46.2'sinde parsiyel yanıt, %15.4'ünde stabil hastalık, %30.8'inde progresyon saptandı. Sonuç: Çalışmamızda mikrosatellit instabilitenin kötü prognostik faktörlerle ilişkisi gösterilmiş olup ilerleyen dönemlerde prognostik bir belirteç olarak kullanılabileceğini ve MSI hastaların kemoterapiye daha kötü yanıt vermeleri sebebiyle immünoterapi için ideal hastalar olabileceklerini düşünmekteyiz. Anahtar Kelimeler: Endometrium kanseri, mikrosatellit instabilite (MSI), mikrosatellit stabil (MSS), prognostik faktörler, kemoterapi yanıtı
Introduction and Aim: Endometrial Cancer is the most common gynecological malignancy in developed countries. In our study, it was aimed to examine the effect of microsatellite instability (MSI) on the prognosis and treatment response of the disease in cases with endometrial cancer admitted to our hospital by immunohistochemical methods. Materials and Methods: 204 patients diagnosed with endometrial cancer between 2018 and 2022 were included. Microsatellite instability was investigated by immunohistochemical methods using MLH1, MSH2, MSH6 and PMS2 markers. Patients with instability in at least one locus were considered as MSI, and patients without instability were considered as MSS (microsatellit stable). These two groups were compared in terms of prognostic factors and chemotherapy response. Results: When 204 patients diagnosed with endometrial cancer were examined in our study, the mean age was 61.46 (±10.48). Of the patients, 55 (26.96%) were found to be MSI, and 149 (73.04%) were MSS. The most common loss of expression was observed as mlh-1/pms-2. It was found statistically significant that the stage at the time of diagnosis was higher in patients with MSI than in patients with MSS (p<0.001). When the patients grade, myometrial invasion, lymphovascular invasion and lymph node metastases were evaluated, these parameters were found to be statistically significantly higher in MSI patients compared to MSS patients (p<0.001). The following responses were observed in 11 patients who received chemotherapy, 72.7% complete response, 9.1% partial response, 9.1% stable disease, 9.1% progression. In 13 MSI patients who received chemotherapy, 7.7% had complete response, 46.2% partial response, 15.4% stable disease and 30.8% progression were determined. Conclusion: In our study, it has been shown that microsatellite instability is associated with poor prognostic factors and we think that it can be used as a prognostic marker in the future and MSI patients may be ideal patients for immunotherapy because they respond worse to chemotherapy. Keywords: Endometrial cancer, microsatellite instability (MSI), microsatellite stable (MSS), prognostic factors, chemotherapy response
Introduction and Aim: Endometrial Cancer is the most common gynecological malignancy in developed countries. In our study, it was aimed to examine the effect of microsatellite instability (MSI) on the prognosis and treatment response of the disease in cases with endometrial cancer admitted to our hospital by immunohistochemical methods. Materials and Methods: 204 patients diagnosed with endometrial cancer between 2018 and 2022 were included. Microsatellite instability was investigated by immunohistochemical methods using MLH1, MSH2, MSH6 and PMS2 markers. Patients with instability in at least one locus were considered as MSI, and patients without instability were considered as MSS (microsatellit stable). These two groups were compared in terms of prognostic factors and chemotherapy response. Results: When 204 patients diagnosed with endometrial cancer were examined in our study, the mean age was 61.46 (±10.48). Of the patients, 55 (26.96%) were found to be MSI, and 149 (73.04%) were MSS. The most common loss of expression was observed as mlh-1/pms-2. It was found statistically significant that the stage at the time of diagnosis was higher in patients with MSI than in patients with MSS (p<0.001). When the patients grade, myometrial invasion, lymphovascular invasion and lymph node metastases were evaluated, these parameters were found to be statistically significantly higher in MSI patients compared to MSS patients (p<0.001). The following responses were observed in 11 patients who received chemotherapy, 72.7% complete response, 9.1% partial response, 9.1% stable disease, 9.1% progression. In 13 MSI patients who received chemotherapy, 7.7% had complete response, 46.2% partial response, 15.4% stable disease and 30.8% progression were determined. Conclusion: In our study, it has been shown that microsatellite instability is associated with poor prognostic factors and we think that it can be used as a prognostic marker in the future and MSI patients may be ideal patients for immunotherapy because they respond worse to chemotherapy. Keywords: Endometrial cancer, microsatellite instability (MSI), microsatellite stable (MSS), prognostic factors, chemotherapy response
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