İleri evre küçük hücreli dışı akciğer kanseri hastalarında medikal tedavi ile sarkopeni arasındaki ilişki
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Giriş: İskelet kası kütlesi ve işlevi kaybı ile karakterize edilen sarkopeni kanser hastalarında daha kötü klinik sonuçlarla ilişkilidir. Kanser tedavisi sarkopeni gelişimini etkileyebilir. Buna karşın tedavi öncesi veya sonrası sarkopeni varlığı kanser tedavisinde yanıtı etkileyebilir. Bu kısır döngü daha yüksek mortalite riski ile ilişkilendirilmektedir. Bu çalışmanın amacı yeni tanı ileri evre küçük hücreli dışı akciğer kanseri (KHDAK) hastalarında standart kemoterapi protokolü uygulanmasından önce ve sonra sarkopeni sıklığını belirlemek ve sarkopeni ile tedavi yanıtı arasındaki ilişkiyi araştırmaktır. Metod: Çalışmaya 13.10.2022-13.02.2023 tarihleri arasında Tıbbi Onkoloji Bilim Dalı Polikliniği'ne başvuran ileri evre KHDAK tanısı almış 18 yaş üstü 38 hasta dahil edildi. Tüm hastaların biyoelektrik impedans analizi (BİA) ile antropometrik ölçümleri yapıldı. Kas gücünün değerlendirilmesi için elektronik bir el dinamometresi ile ölçülen el sıkma gücü kullanıldı. Kas performansı ise 4 metrelik parkurda ölçülen yürüme hızı ile değerlendirildi. Yürüme hızı <0,8 m/sn azalmış kas performansı lehine değerlendirildi. Sarkopeni tanısı EWGSOP çalışma grubunun kriterleri baz alınarak konuldu. Bulgular: Tedavi öncesi hastaların %23,7'sinde olası sarkopeni, %10,5'inde sarkopeni ve %15,8'inde ciddi sarkopeni saptandı. Tedavi öncesi sarkopenisi olmayan hastaların %21,1'inde sarkopeni gelişirken, olası sarkopenisi olan hastaların da %21,1'inde tedavi sonrası ciddi sarkopeni gelişti. Tedavi sonrası sarkopeni skoru artan hastalarda ECOG performans skoru ve saturasyon düzeyi kötüleştiği belirlenirken, hastaların önemli bir kısmının trombositopeni eğilimi altında olduğu saptandı. Tedavi öncesi sarkopeni varlığı olan hastaların %30'u tedavi sonrası ex olurken, kalan hastaların tamamında tedavi sonrası progresyon saptandı. Tedavi sonrası sarkopeni skoru değişmeyen hastalarda tedavi sonrası BİA parametrelerinde önemli farklılık saptanmazken, D vitamini düzeyinin arttığı belirlendi. Tedavi sonrası sarkopeni skoru artan hastalarda yağsız ağırlık ve yağsız kütle indeksinde önemli azalma saptanmasının yanı sıra D vitaminin düzeyinin de azaldığı belirlendi. Adenokarsinom alt tipi, Evre 4 ve platin bazlı kemoterapi tedavi sonrası sarkopeni skorunda artış ile ilişkili saptandı. Sonuç: KHDAK hastalarında sarkopeni prevelansını yaklaşık %50 civarındadır ve hastalığın evresi, tipi ve tedavi rejimi sarkopeni gelişiminde önemli rol oynar. Tedavi öncesi sarkopeni varlığı tedavi yanıtını etkileyebilir ve kemoterapiye bağlı toksisite riskini arttırabilir. Ayrıca daha yüksek mortalite riski ile ilişkilidir. Anahtar kelimeler: Akciğer kanseri, biyoelektrik impedans, ileri evre kanser, kemoterapi, sarkopeni.
ABSTRACT Aims: Sarcopenia, characterized by loss of skeletal muscle mass and function, is associated with worse clinical outcomes in cancer patients. Cancer treatment may affect the development of sarcopenia. In contrast, the presence of sarcopenia before or after treatment may affect treatment response. This vicious circle is associated with a higher risk of mortality. The aim of this study was to determine the frequency of sarcopenia before and after the standard chemotherapy protocol in newly diagnosed advanced non-small cell lung cancer patients and to investigate the relationship between sarcopenia and treatment response. Method: A total of 38 patients over the age of 18 who were diagnosed with advanced NSCLC in Medical Oncology Department Polyclinic between 13.10.2022-13.02.2023 were included in the study. Anthropometric measurements of all patients were performed with bioelectrical impedance analysis (BIA). Muscle strength was assessed by hand grip strength measured using an electronic hand dynamometer. Muscle performance was evaluated by walking speed measured on a 4-meter track. Decreased muscle performance was evaluated as walking speed <0.8 m/s. The diagnosis of sarcopenia was made based on the EWGSOP criteria. Results: At baseline, 23.7% of patients had probable sarcopenia, 10.5% had sarcopenia, and 15.8% had severe sarcopenia. While 21.1% of patients without sarcopenia before treatment developed sarcopenia, 21.1% of patients with probable sarcopenia developed severe sarcopenia after treatment. It was determined that ECOG performance score and saturation level deteriorated in patients whose sarcopenia score increased after treatment, while a significant portion of the patients were found to be under thrombocytopenia tendency. While 30% of the sarcopenia patients before treatment died after the treatment, progression was found in all the remaining patients. In patients whose sarcopenia score did not change after treatment, there was no significant difference in BIA parameters after treatment, while vitamin D levels were found to increase. In patients with increased sarcopenia scores after treatment, a significant decrease was observed in lean weight and lean mass index, as well as a decrease in vitamin D levels. Adenocarcinoma subtype, stage 4, and platinum-based chemotherapy were associated with an increase in sarcoenia score after treatment. Conclusion: The prevalence of sarcopenia in NSCLC patients is approximately 50%, and the stage, type and treatment regimen of the disease play an important role in the development of sarcopenia. Presence of sarcopenia before treatment may affect treatment response and increase the risk of chemotherapy-related toxicity. It is also associated with a higher risk of mortality. Keywords: Lung cancer, bioelectrical impedance, advanced cancer, chemoradiotherapy, sarcopenia.
ABSTRACT Aims: Sarcopenia, characterized by loss of skeletal muscle mass and function, is associated with worse clinical outcomes in cancer patients. Cancer treatment may affect the development of sarcopenia. In contrast, the presence of sarcopenia before or after treatment may affect treatment response. This vicious circle is associated with a higher risk of mortality. The aim of this study was to determine the frequency of sarcopenia before and after the standard chemotherapy protocol in newly diagnosed advanced non-small cell lung cancer patients and to investigate the relationship between sarcopenia and treatment response. Method: A total of 38 patients over the age of 18 who were diagnosed with advanced NSCLC in Medical Oncology Department Polyclinic between 13.10.2022-13.02.2023 were included in the study. Anthropometric measurements of all patients were performed with bioelectrical impedance analysis (BIA). Muscle strength was assessed by hand grip strength measured using an electronic hand dynamometer. Muscle performance was evaluated by walking speed measured on a 4-meter track. Decreased muscle performance was evaluated as walking speed <0.8 m/s. The diagnosis of sarcopenia was made based on the EWGSOP criteria. Results: At baseline, 23.7% of patients had probable sarcopenia, 10.5% had sarcopenia, and 15.8% had severe sarcopenia. While 21.1% of patients without sarcopenia before treatment developed sarcopenia, 21.1% of patients with probable sarcopenia developed severe sarcopenia after treatment. It was determined that ECOG performance score and saturation level deteriorated in patients whose sarcopenia score increased after treatment, while a significant portion of the patients were found to be under thrombocytopenia tendency. While 30% of the sarcopenia patients before treatment died after the treatment, progression was found in all the remaining patients. In patients whose sarcopenia score did not change after treatment, there was no significant difference in BIA parameters after treatment, while vitamin D levels were found to increase. In patients with increased sarcopenia scores after treatment, a significant decrease was observed in lean weight and lean mass index, as well as a decrease in vitamin D levels. Adenocarcinoma subtype, stage 4, and platinum-based chemotherapy were associated with an increase in sarcoenia score after treatment. Conclusion: The prevalence of sarcopenia in NSCLC patients is approximately 50%, and the stage, type and treatment regimen of the disease play an important role in the development of sarcopenia. Presence of sarcopenia before treatment may affect treatment response and increase the risk of chemotherapy-related toxicity. It is also associated with a higher risk of mortality. Keywords: Lung cancer, bioelectrical impedance, advanced cancer, chemoradiotherapy, sarcopenia.
Açıklama
Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı, İç Hastalıkları Bilim Dalı
Anahtar Kelimeler
Onkoloji, Oncology
