Title Analiza utjecaja adjuvantnog liječenja s 5-fluorouracilom i leukovorinom u bolesnika s rakom debelog crijeva : doktorski rad Author Ingrid Belac-Lovasić Mentor Marija Petković (mentor)306462385 Mentor Dražen Kovač (komentor)Committee member Zlatko Trobonjača (predsjednik povjerenstva)Committee member Mirko Šamija (član povjerenstva)Committee member Arsen Depolo (član povjerenstva)Committee member Marija Petković (član povjerenstva)306462385 Committee member Dražen Kovač (član povjerenstva)Granter University of Rijeka Defense date and country 2011-12-02, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Uvod: Kolorektalni karcinom je po učestalosti drugi najčešći maligni tumor u razvijenim zemljama, s oko milijun novih slučajeva u svijetu svake godine, praćen visokom stopom smrtnosti. Po uzroku smrtnosti od karcinoma ovaj karcinom je u Republici Hrvatskoj na drugom mjestu, iza karcinoma pluća. Liječenje većine bolesnika započinje kirurškim zahvatom, a izbor pravilne terapije u daljnjem liječenju može doprinjeti boljoj kvaliteti života i dužem preživljenju.
Cilj istraživanja: Ispitivali smo stopu preživljenja i ponovno pojavljivanje (pojava udaljenih metastaza i/ili lokalnih recidiva) bolesnika s rakom debelog crijeva i rektuma stadija Dukes B i C u Primorsko-goranskoj i Istarskoj županiji koji su primali adjuvantnu kemoterapija, u usporedbi s onima koji nisu, u razdoblju od 1980. do 1999.
Materijal i postupci: Ovaj rad obuhvaća 483 pacijenata s rakom debelog crijeva stadija II i III Primorsko-goranske i Istarske županije, koji su bili podvrgnuti resekciji raka debelog crijeva ili rektuma u KBC Rijeka, a zatim se liječeli kemoterapijom s 5-fluorouracilom i leukovorinom (288) ili nisu primili kemoterapiju (195). Analizirali smo petogodišnju i osmogodišnju stopu preživljenja, pojavnost lokoregionalnog recidiva i metastaza u skupini liječenoj adjuvantnom kemoterapijom u usporedbi sa skupinom netretiranom kemoterapijom, ovisno o stadiju bolesti, stupnju histološke diferencijacije, dobi i lokalizaciji raka (debelog crijeva ili rektuma). Statistička obrada podataka učinjena je u programu „SPSS 16.0 for Windows“.
Rezultati: Nakon praćenja od 60 mjeseci umrlo je 44,79% (129/288) bolesnika koji su primali kemoterapiju i 53,33% (104/195) bolesnika koji nisu primili kemoterapiju. Relativni rizik od smrti (iz bilo kojeg uzroka) u skupini liječenoj adjuvantnom kemoterapijom u odnosu na grupu bez kemoterapije je 0,82 (p<0,008). Recidiv maligne bolesti (pojava udaljenih metastaza i/ili lokalnog recidiva) u skupini liječenoj adjuvantnom kemoterapijom je iznosio 38,54 (111/288), a u skupini bez kemoterapije 46,15% (90/195). Pojava udaljenih metastaza nakon treće godine od operacije u skupini s kemoterapijom u odnosu na grupu bez kemoterapije bila je statitstički značajno manja (p=0,0327). Nije bilo statistički značajne razlike u učinkovitosti liječenja u odnosu na lokalizaciju tumora i stupanj histološke diferencijacije tumora, ali postoje razlike u učinkovitosti s obzirom na stadij bolesti, i dob.
Zaključak: Kemoterapija s 5-fluorouracilom i leukovorinom poboljšava preživljenje i smanjuje recidiv i pojavu udaljenih metastaza u bolesnika s rakom debelog crijeva stadija Dukes B i Dukes C, a poboljšanje preživljenja, i smanjenje pojavnosti recidiva i udaljenih metastaza izraženije je u bolesnika stadija Dukes C. Pojava udaljenih metastaza u skupini s kemoterapijom nakon treće godine od operacije je statistički znaćajno manja.
Abstract (english) Introduction: Colorectal cancer is the second most common malignant disease in developed countries, with about one million new cases worldwide every year, accompanied with high mortality rate. According to cause of cancer death, this cancer is on the second place in Republic of Croatia, beyond the lung cancer. The treatment begins with a surgical intervention in the majority of patients, and choice of correct treatment in further therapy could contribute better quality of life and longer survival.
The aim of this study: To analyse the survival rate and the appearance of local recurrences and/or distant metastases in patients with colorectal cancer stages Dukes B and C of Primorsko-Goranska and Istarska county, in the adjuvant treatment group in comparison with not treated group with chemotherapy, in the period since 1980. until 1999.
Matherials and Methods: We analysed 483 patients with colorectal cancer stages Dukes B and C of Primorsko-Goranska and Istarska county who were treated with radical surgical resection in the Clinical Hospital Center Rijeka, and then healing with chemotherapy with 5-fluorouracil and leucovorin (288), or not healing with chemotherapy (195). We analysed five-year and eight-year survival rate and the appearance of local recurrences and/or distant metastases in group treated with adjuvant chemotherapy in comparison with not treated group depending on the stage of disease, degree of histological differentiation, patient age and location of cancer (colon or rectum). Statistical evaluation of data was done in the programme “SPSS 16.0 for Windows”.
Results: After follow-up of 60 months died 44.79% (129/288) of patients who received chemotherapy and 53.33% (104/195) of patients who did not receive chemotherapy. The relative risk of death (from any cause) in chemotherapy-treated group versus the group without chemotherapy was 0.82 (p<0,008). Recurrence of malignant disease (distant metastases and/or local recurrences) in the chemotherapy group was 38.54% (111/288), and in the group without chemotherapy was 46.15% (90/195). The lower appearance of distant metastases third year after operation in the chemotherapy group versus the group without chemotherapy was statistically significant (p=0,0327). There was no difference in treatment efficacy regard to the localization of the tumor, but there were differences in efficiency with respect to disease stage, grade and age.
Conclusion: Chemotherapy with 5-fluorouracil and leukovorin ameliorate the survival and reduces recurrence and distant metastases in patients with colorectal cancer stages Dukes B and C, also improvement is better in patients with colorectal cancer stage Dukes C. The lower appearance of of distant metastases third years after operation in the chemotherapy group is statistically significant.
Keywords
adjuvantna kemoterapija
5-fluorouracil
kolorektalni karcinom
petogodišnje preživljenje
Istarska županija
Primorsko-Goranska županija
Keywords (english)
adjuvant chemotherapy
colorectal cancer
five-year survival rate
Istarska County
Primorsko-Goranska County
Language croatian URN:NBN urn:nbn:hr:188:649638 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Catalog URL http://libraries.uniri.hr/cgi-bin/ucat/unilib.cgi?form=D1121030017 Type of resource Text Extent 176 str; 30 cm File origin Born digital Access conditions Closed access Terms of use Created on 2017-01-19 18:39:22
