| Abstract | Incidencija karcinoma orofarinksa u Hrvatskoj i svijetu je u porastu što predstavlja značajan javnozdravstveni problem. Unatoč identifikaciji različitih faktora rizika poput pušenja, konzumacije alkohola i infekcije HPV-om kompletna patogeneza ovih karcinoma još uvijek nije u potpunosti razjašnjena. Posljednjih godina istraživanje utjecaja kronične upale na karcinome glave i vrata, pa tako i orofarinksa privlači sve više pažnje te se nastoji pronaći visoko specifične, visoko osjetljive, jeftine i široko dostupne biomarkere koji bi se mogli koristiti u rutinskim laboratorijskim pretragama kao pouzdani indikatori ishoda bolesti kod pacijenata.
Cilj ovog rada bio je istražiti utjecaj upalnih parametara iz rutinskih laboratorijskih nalaza napravljenih prije početka liječenja na ishode liječenja orofaringealnog karcinoma. U ovo retrospektivno kohortno istraživanje uključena su 92 pacijenta koji su liječeni zbog patohistološki potvrđenog orofaringealnog karcinoma na Klinici za bolesti uha, grla i nosa Kliničkog bolničkog centra Zagreb tijekom desetogodišnjeg razdoblja.
Učinjena je Cox-ova univarijantna i multivarijantna regresijska analiza za vrijeme preživljenja bez progresije bolesti i ukupno preživljenje koja je u obzir uzela NLR, PLR, SIRI, SII, CRP i fibrinogen zajedno demografskim i kliničko-patološkim karakteristikama pacijenata. ROC analizom i primjenom Youdenova indeksa dobivene su granične vrijednosti od 2.94 za NLR, 162.3 za PLR, 1.18 za SIRI, 728.4 za SII, za fibrinogen 4.2 i 4.3. za CRP. Kaplan-Meierova krivulje ukupnog preživljenja stratificirane su prema graničnoj vrijednosti NLR, PLR, SIRI, SII, CRP i fibrinogena.
U univarijantnoj analizi za preživljenje bez progresije bolesti kao pokazatelji lošijeg ishoda pokazali su se povišeni SIRI i CRP, a u multivarijantnoj analizi povišeni NLR i PLR. Za ukupno preživljenje u univarijantnoj analizi kao indikatori lošijeg preživljenja značajnim su se pokazali NLR, PLR, SIRI, SII, fibrinogen i CRP, dok su se u multivarijantnoj analizi kao značajni zadržali PLR, SIRI, fibrinogen i CRP. U ovom istraživanju kao najznačajniji pokazatelj lošijeg ishoda pokazao se omjer trombocita i limfocita, PLR.
Potrebna su daljnja prospektivna istraživanja na većim skupinama pacijenata kako bi se utvrdila klinička primjenjivost ovih biomarkera u prognozi kod pacijenata s orofaringealnim karcinomom. |
| Abstract (english) | The incidence of oropharyngeal cancer in Croatia and worldwide is increasing, which represents a significant public health problem. Despite the identification of various risk factors such as smoking, alcohol consumption, and HPV infection, the complete pathogenesis of these cancers is still not fully understood. In recent years, research on the impact of chronic inflammation on head and neck cancers, including oropharyngeal cancer, has been receiving increasing attention, with efforts to find highly specific, highly sensitive, cost-effective, and widely available biomarkers that could be used in routine laboratory tests as reliable indicators of disease outcomes in patients.
The aim of this study was to investigate the impact of inflammatory parameters from routine laboratory findings taken before the start of treatment on the treatment outcomes of oropharyngeal cancer. This retrospective cohort study included 92 patients who were treated for histopathologically confirmed oropharyngeal cancer at the Clinic for Ear, Nose, and Throat Diseases of the Clinical Hospital Center Zagreb during a ten-year period.
Cox univariate and multivariate regression analysis was performed for progression-free survival and overall survival, taking into account NLR, PLR, SIRI, SII, CRP, and fibrinogen, along with demographic and clinicopathological characteristics of the patients. ROC analysis and the application of the Youden index yielded cutoff values of 2.94 for NLR, 162.3 for PLR, 1.18 for SIRI, 728.4 for SII, 4.2 and 4.3 for fibrinogen and CRP, respectively. Kaplan-Meier survival curves were stratified according to the cutoff values of NLR, PLR, SIRI, SII, CRP, and fibrinogen.
In the univariate analysis for progression-free survival, elevated SIRI and CRP were identified as indicators of poorer outcomes, while elevated NLR and PLR were found significant in the multivariate analysis. For overall survival, NLR, PLR, SIRI, SII, fibrinogen, and CRP were identified as significant indicators of poorer survival in the univariate analysis, while PLR, SIRI, fibrinogen, and CRP remained significant in the multivariate analysis. The most significant indicator of poorer outcomes in this study was the platelet-to-lymphocyte ratio (PLR).
Further prospective studies on larger patient populations are needed to determine the clinical applicability of these biomarkers in the prognosis of patients with oropharyngeal cancer. |
