Orta yüksek risk grubu endometrium kanseri olgularında prognozu etkileyen faktörler
Factors affecting prognosis in moderate high risk group endometrial cancer cases
Yazar: EREN CAN GÜLERYÜZ
Danışman: DOÇ. DR. VAKKAS KORKMAZ
Sağlık Bakanlığı / Ankara Etlik Şehir Hastanesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: Onkoloji = Oncology

Özet:
Giriş ve Amaç: Endometrium kanseri (EK) gelişmiş ülkelerde en yaygın 
görülen jinekolojik kanser türüdür. EK'nin primer tedavisi cerrahidir. Hastalığın 
cerrahi tedavisi tamamlandıktan sonra adjuvan tedavi konusunda ESMO-ESTROESGO sınıflaması yaygın olarak kullanılmaktadır. Bu sınıflamaya göre evre 1 LVSI 
(+) hastalar (grade ve miyometrial invazyondan bağımsız), evre 1B grade 3 hastalar 
(LVSI'dan bağımsız) ve evre 2 hastalar orta yüksek risk grubu olarak 
sınıflandırılmıştır. Bu çalışmanın amacı, EK nedeniyle opere edilen olgularda orta 
yüksek risk sınıflamasına giren hastaların sağkalımını etkileyen faktörlerin 
belirlenmesidir.
Gereç ve Yöntem: Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve 
Araştırma Hastanesi ve Ankara Etlik Şehir Hastanesi Kadın Hastalıkları ve Doğum 
Anabilim Dalı Kliniği'nde 2011-2023 yılları arasında EK nedeniyle tedavi edilen 1163 
hasta retrospektif olarak değerlendirilmiştir. Bu hastalar içerisinden çalışma 
kriterlerimizi karşılayan ESMO-ESGO-ESTRO prognostik risk grubu 
sınıflandırmasına göre orta yüksek risk grubu endometrioid tip endometrium kanseri 
(EEK) olan 140 hasta çalışmamızda retrospektif olarak değerlendirilmiştir. Ayrıca 
dahil edilen hastalar ESMO-ESGO-ESTRO prognostik risk grubu sınıflandırmasına 
göre evre 1 LVSI (+) olanlar (grade ve miyometrial invazyondan bağımsız) (Grup 1, 
n= 79), evre 1B grade 3 olanlar (LVSI'dan bağımsız) (Grup 2, n=17) ve evre 2 olanlar 
(Grup 3, n=44) olmak üzere 3 subgruba ayrılarak karşılaştırılmıştır.
Bulgular: Dahil edilen hastaların yaş ortalaması 58,85±9,35 (min:33-
maks:88)'dir. BMI 31,78±4,39, tümör çapı ortanca değeri 4 (min:1, maks:13)'tür. 
Miyometrial invazyon derinliği 6 (%4,3) hastada endometriuma sınırlı, 64 (%45,7) 
hastada <%50, 70 (%50,0) hastada ≥%50 miyometrial invazyon şeklindedir. LVSI 
hastaların 92 (%65,7)'sinde (+)'tir. Hastaların 41 (%29,3)'i evre 1A, 55 (%39,3)'i evre 
1B, 44 (%31,4)'ü evre 2'dir. 51 (%36,4) hasta grade 1, 47 (%33,6) hasta grade 2, 42
(%30) hasta grade 3'tür. Tüm hastalarda 10 yıllık DFS ve OS oranları sırasıyla %82,5 
ve %85,9 bulunmuştur. Dahil edilen hastalar subgruplara ayrılarak incelendiğinde, 
viii
grup 1'de 10 yıllık DFS ve OS oranları sırasıyla %79,6 ve %81,9; grup 2'de %94,1 ve 
%100; grup 3'te ise %84,9 ve %89,3 olarak bulunmuştur (p>0,05). Tüm hastalarda 
yapılan tek değişkenli regresyon analizinde yaş, miyometrial invazyon, ameliyat türü
ve pelvik lenf nodu sayısı DFS'yi; yaş, miyometrial invazyon ve pelvik lenf nodu 
sayısı ise OS'yi etkileyen prognostik faktörler olarak bulunmuştur (p<0,05). 
Multivaryant analiz sonuçları, grup 3'de yaşın DFS'yi etkilemesi (p<0,05) dışında 
anlamsız bulunmuştur (p>0,05). Yüksek orta risk grubuna göre subgruplara ayrılarak 
yapılan sağkalım analizinde DFS ve OS'ye göre sağkalım oranları arasında istatistiksel 
olarak anlamlı fark elde edilmemiştir (p>0,05).
Sonuç: Yüksek orta risk grubundaki EK olgularında 10 yıllık DFS ve OS 
değerleri sırasıyla %82,5 ve %85,9 olarak bulunmuştur. Subgruplara ayrılarak analiz 
edildiğinde sağkalım açısından fark saptanmamıştır. Yaş, ameliyat türü, miyometrial 
invazyon derinliği ve pelvik lenf nodu sayısı bu olgularda sağkalımı etkileyen 
prognostik faktörlerdir. Ancak hiçbiri bağımsız risk faktörü olarak bulunmamıştır.
Anahtar Sözcükler: Endometrium kanseri, orta yüksek risk, prognoz

Abstract:
Objectives: Endometrial cancer (EK) is the most common type of 
gynecological cancer in developed countries. Incidence and death rates tend to 
increase around the world. Generally EC is a disease of postmenopausal women and 
most EC patients are diagnosed between the ages of 65-75. However, the number of 
patients diagnosed under the age of 50 is increasing day by day. EC can be diagnosed 
at early stage because it shows symptoms earlier than other gynecological cancers. 
67% of patients are diagnosed with early stage EC. Their 5-year overall survival rate 
(OS) is 81%. In stage IVA and IVB disease, these rates decrease to 17% and 15%, 
respectively. Advanced age, advanced tumor stage, advanced histological grade, 
comorbidities and obesity are among the factors that reduce survival in EC. Other 
important prognostic factors include depth of myometrial invasion, histological type, 
peritoneal cytology, lenfovascular space invasion (LVSI) and progesterone receptor 
activity. It is important to evaluate the factors affecting the prognosis of EC, whose 
prevalence tends to increase in the world, and their effects on survival. The aim of this 
study is to determine the factors affecting the survival of patients classified as high
intermediate risk in cases operated on due to EC.
Materials and Methods: 1163 patients treated for EC between 2011 and 2023 
at Ankara Etlik City Hospital Etlik Zübeyde Hanım Gynecology Training and 
Research Hospital Gynecology and Obstetrics Department Clinic were retrospectively 
evaluated. Among these patients, 140 patients with endometrioid type endometrial 
cancer (EEC) in the medium-high risk group according to the ESMO-ESGO-ESTRO 
prognostic risk group classification, who met our study criteria, were evaluated 
retrospectively in our study. Additionally, the patients included were those with stage 
1 LVSI (+) (independent of grade and myometrial invasion) (Group 1, n= 79), those 
with stage 1B grade 3 (independent of LVSI) (Group) according to the ESMO-ESGOESTRO prognostic risk group classification. They were divided into 3 subgroups: 
Stage 2, n=17) and Stage 2 (Group 3, n=44).
x
Results: 140 patients participated in the study. Patients were included and 
evaluated in 3 groups: 79 (56.4%) in group 1 [LVSI (+) Stage 1], 17 (12.1%) in group 
2 [LVSI (-) Stage 1B Grade 3] and 44 (31.4%) in group 3 (Stage 2). The average age 
of all patients is 58.85±9.35 (min: 33-max: 88). BMI is 31.78±4.39, tumor diameter 
median value is 4 (min: 1, max: 13). Myometrial invasion depth was limited to the 
endometrium in 6 (4.3%) patients, <50% in 63 (45.0%) patients, ≥50% in 70 (50.0%) 
patients, and serosa invasion in 1 (0.7%) patient. LVSI was (+) in 90 (64.3%) of the 
patients. 41 (29.3%) of the patients are stage 1A, 55 (39.3%) are stage 1B, and 44 
(31.9%) are stage 2. 51 (36.4%) patients were grade 1, 48 (34.3%) patients were grade 
2, and 40 (28.6%) patients were grade 3. The 10-year DFS and OS rates in all patients 
were 82.5% and 85.9%, respectively. When the included patients were divided into 
subgroups and examined, the 10-year DFS and OS rates in group 1 were 79.6 % and 
81.9%, respectively; 94.1% and 100% in group 2; In group 3, it was found to be 84.9% 
and 89.3%. In the univariate regression analysis performed on all patients; age, type 
of surgery, myometrial invasion and pelvic lymph node number affected DFS. Age, 
myometrial invasion and number of pelvic lymph nodes were found to be prognostic 
factors affecting OS (p<0.05). Multivariate analysis results were found to be 
insignificant, except that age affected DFS in group 3 (p>0.05). In the survival analysis 
performed by dividing into subgroups according to the high-medium risk group, no 
statistically significant difference was found between survival rates according to DFS 
and OS (p>0.05).
Conclusion: In EC cases in the high-medium risk group, 10-year DFS and OS 
values were found to be 82,5% and 85.9%, respectively. Survival is similar when 
analyzed by subgroups. Age, type of surgery, depth of myometrial invasion and 
number of pelvic lymph nodes are prognostic factors affecting survival in these cases. 
However, none of them are independent risk factors for AD.
Key words: Endometrial cancer, high intermediate risk, prognosis