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  • Značenje morfoloških i imunohistokemijskih prognostičkih pokazatelja kod bolesnika nakon radikalne resekcije želuca zbog karcinoma želuca : magistarski rad
    Potrč, Stojan
    Background: In so called "high volume" institutions with great experience in gastric surgery an expected 5-year survival for patients after gastric resection treated for gastric cancer is 40-50 %. ... Prognostic factors are factors that influence the prognosis of the disease. The aim of the study was to verify the classic clinico-pathological prognostic factors of the expected survival, to determine the frequency of imunohistochemical factors (C-erB-2, p53 and bcl-2) and to verify this imunohistochemical factors in its function as prognostic factors in gastric cancer patients after potentially curative gastric resection (R0) has been performed. The aim of the study was to determine the frequency of imunohistochemical factors (p53, bcl-2 in C-erB-2) in tumor tissue and to prove their role as a prognostic factor in a univariate and multivariate analysis. Classical clinicopathological factors were analysed in the same way. Methods: In a retrospective study, prospectively collected data of 81 patients operated with a potentially curative resection for gastric cancer in 4 year period (from 01. 01. 1995 to 31. 12. 1998), were analyzed. Clinico-pathological factors which were analyzed in univariate analysis were age, gender, diameter of the tumor, grade of differentiation, Lauren histological classification, deepness of invasion, metastatic implementation of lymph nodes, and tumor stage according to UICC. Imunohistochemical factors we studied in a univariate analysis were: C-erbB-2, p53 and bcl-2. Clinico-pathological and imunohistochemical factors were further analyzed in a multivariate analysis. Statistical methods: [Chi] test, t-test (Student's test), Kaplan-Meier's method of calculation of survival and life tabels, Log-Rank test, Cox's regression method; A SPSS 10-0 program was used for statistical calculation. Results: The majority of patients (86.5 %) were older than 50 years. The study showed the age and ASA to be important prognostic factors (p<0.05 for age and ASA). According to present study the UICC stage is the most significant prognostic factor (p<0.001). With a Cox regression model we were able to demonstrate that the extend of lymphadenectomy (number of extirpated lymph nodes) is of frank importance (p<0.05). The frequency of C-erB-2 positive patients was 18.5 %. Analyzing patients on C-erB-2 oncogen we didn't find any significant differences regarding gender (p=0.33), location of the tumor (p=0.15), diameter of the tumor (p=0.29) and differentiation of the tumor cells (p=0.33). Deepness of invasion (T) (p=0.10), metastatic implementation of lymph nodes (N) (p=0.44), and tumor stage according to UICC (p=0.10), factors that reflect the progression of the disease, didn't show significant statistical differences. The difference between C-erbB-2 positive and negative patients after the age of 65 and in intestinal type of carcinoma is statistical significant (age>65: 29,5% vs 7%; p=0,035; intestinal type: 57% vs 14%; p=0.47). The 5-year survival in group of C-erB-2 positive patients was lower than in C-erB-2 negative patients (37.4% vs. 53.3%) but didn't reach the statistical significance (p=0.94). In a subgroup of patients with advanced gastric cancer (UICC stage IIIb and IV) C-erB-2 negative patients had significant advantage in survival (11,1% vs 0%; p=0,018). The frequency ofp53 positive patients was 42% and there was no difference in regard to gender (p=0.39), age (p=0.34), Lauren classification (p=0.10), differentiation of the tumor cells (p=0.74), deepness of tumor invasion (T) (p=0.50), metastatic implementation of lymph nodes (N) (p=0.74) and UICC stage (p=0.90). According to our study, the frequency of p53 positive patients is significantly higher in lower two thirds than in the upper third (91% vs. 9%, (p=0.0008). p53 positive patients have a better 5-year survival (46.2% vs. 33,5%) comparing with p53 negative patients eventhought the difference is not significant (p=0.47).The frequency of Bcl-2 positive patients was only 6.2 %. Probably because of low number of the patients in this group there were no significant differences regarding gender, age, Lauren classification, differentiation of the tumor cells, deepness of tumor invasion (T), metastatic implementation of lymph nodes (N) and UICC stage. There were no significant differences between Bcl-2 positive and negative patients in different calculation for expected 5-year survival. Conclusion: The most important prognostic factor in patients after potentially radical (R0) gastrectomy with D2 lymphadenectomy for gastric cancer is UICC stage, but very important prognostic factors are also the number of excised lymph nodes, age and the ASA value.Imunohistochemical methods are suitable for determination of antigens for C-erB-2, p53 and Bcl-2,but are not able to register the subtile molecular change which determinates biological aggressiveness of the tumor. The imunohistochemical determination of p53 and Bcl-2 alone or in combination can not be suggested asa prognostic factor. Since there is a significant survival benefit in C-erB-2 positive patients with advanced gastric cancer (UICCstage IIIb and IV), it would make sense to prove C-erB-2 as a prognostic factors for advanced tumor stages.
    Vrsta gradiva - magistrsko delo ; neleposlovje za odrasle
    Založništvo in izdelava - Zagreb : [S. Potrč], 2003
    Jezik - hrvaški
    COBISS.SI-ID - 2035519

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