Sorafenib veya regorafenib tedavisi almış hcc tanılı hastalarda hastalığın prognozu ve tedavi etkinliğini belirlemede AL-Bİ skoru ile Child Pugh skorunun karşılaştırılması
Comparison of AL-BI score and child-pugh score in determining the prognosis of the disease and the effectiveness of treatment in patients diagnosed with HCC who received sorafenib or regorafenib treatment
Yazar: MERYEM KARABACAK
Danışman: DOÇ. DR. MURAT ARAZ
Necmettin Erbakan Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2024
Konu: İç Hastalıkları = Internal diseases

Özet:
Hepatosellüler kanser; HBV, HCV, NASH, kronik alkolizm, aflatoksin gibi etyolojileri kont-
rol altına alındığı nda yüksek oranda önlenebilen altınc ı en sık kanser olup, kansere bağlı
ölümlerde üçüncü sırada yer alan karaciğerin en sık primer tümörüdür . HCC tedavisinde kan-
serin tedavisine ek olarak karaciğer rezervi ve fonksiyonu tedavi belirlemede önemli yer tut-
mak tadır. Karaciğer (dis)fonksiyonu; sağkalım, tedavi tolerasyonu, ilaç yan etki riski, ikinci
ve diğ er sıra tedavilerin uygulanabilirliğinde o ldukça önemlidir. Tedavide kullanılan algorit-
malarda Child Pugh Skoru ( kullanılagelmiştir. Ancak CPS, sirotik h astalar üzerinde,
varis kanama operasyon sonrası mortalite risk değerlendirmesi için oluşturulmuş, istatistiki
sonuçlarla oluşturulmamış, as s it ve ensefalopati gibi kılavuzlarda sınıflandırılması net olma-
yan subjektif kriterler içer en bir yöntemdir . ALBİ s koru ise 2015 yılında HCC hastaları üze-
rinde Japonya'da Johnson ve arkadaşları tarafınca geniş kohort çalışmalarının analizi ile se-
rum albüm in ve bilirubinden kullanılarak geliştirilmiş basit, uygulanabilir, objektif bir yön-
temdir.
Çalışmamızda HCC ile sorafenib ve/veya regorafenib almış hastaların tedavi öncesi ALBİ
skorunun Child Pugh skoruna göre sağkalım ve progresyon açısından üstünlüğ ü araştırıldı.
Sonuçlarda ; düşük ALBİ skorunun CPS' ye göre ve kendi grupları arasında sağkalımda ista-
tistiksel ol arak anlamlı olmamakla birlikte önemli derecede daha iyi sağkalımla ilişkili olduğu
tes pit edildi. PFS' de anlamlı fark saptanmadı. Ancak hasta sayısının az olması nedeniyle
gruplardaki hasta dağılımları yetersiz olup sonuçlar değerlendirilirken bu kısıtlı lığın göz
önünde bulundurulması önerilir.
Anahtar kelimeler:
hepatoselüler kanser, ALBİ skoru, albümin, bilirubin, Child Pugh skoru,
sorafenib , regorafenib

Abstract:
Hepatocellular cancer; It is the sixth most common cancer that can be prevented at a hi gh
rate when etiologies such as HBV, HCV, NA FLD , chronic alcoh olism and aflatoxin are cont-
rolled, and it is the most common primary tumor of the liver, which ranks third in cancer
related deaths. In HCC treatment, in addition to the treatment of cancer, li ver reserve and
function have an important role in determining treatment. Liver (dys)function is very impor-
tant in s urvival, treatment tolerance, drug side effect risk and applicability of second and other
line treatments. Child Pugh Score (CPS) has been u sed in the algorithms used in HCC treat-
viii
ment. However, CPS was
ment. However, CPS was created for mortality risk assessment after varicose bleeding surgery created for mortality risk assessment after varicose bleeding surgery on cirrhotic patients, was not created with statistical results, and contains subjective criteria on cirrhotic patients, was not created with statistical results, and contains subjective criteria such as ascites and encephsuch as ascites and encephalopathy, which are not clearly classified in the guidelines. alopathy, which are not clearly classified in the guidelines. ALBI ALBI score is a simple, applicable, objective method developed by Johnson et al. in Japan in 2015, score is a simple, applicable, objective method developed by Johnson et al. in Japan in 2015, using serum albumin and bilirubin, through the analysis of large cohort studies on HCC pati-using serum albumin and bilirubin, through the analysis of large cohort studies on HCC pati-entsents. There are many studies in the literature showing the effecti. There are many studies in the literature showing the effectiveness of the ALBI score in veness of the ALBI score in patients who received resection, ablatipatients who received resection, ablation therapyon therapy and sorafenib for HCC.and sorafenib for HCC.
In our study, the superiority of the preIn our study, the superiority of the pre--treatment ALBI score compared to the Childtreatment ALBI score compared to the Child--Pugh Pugh score in terms of survival and progression in patients with HCscore in terms of survival and progression in patients with HCC who received sorafenibC who received sorafenib and/orand/or regorafenib was investigated.regorafenib was investigated.
In the results, it was determined that a low ALBI score was associated with significantly In the results, it was determined that a low ALBI score was associated with significantly better survival compared to CPS and ambetter survival compared to CPS and among its own groups, ong its own groups, but but not statisticallynot statistically. . No No signifi-signifi-cant difference was detected in cant difference was detected in RRFS. However, due to the small number of patients, the distri-FS. However, due to the small number of patients, the distri-bution of patients in the groups is insufficient, and it is recommended that this limitation be bution of patients in the groups is insufficient, and it is recommended that this limitation be taken into contaken into consideration when evaluating the results.sideration when evaluating the results.
Key wo
Key words: rds: hepatocellular cancer, ALBİ score, albumin, bilirubin, Childhepatocellular cancer, ALBİ score, albumin, bilirubin, Child--Pugh score, sorafe-Pugh score, sorafe-nibnib, regorafenib, regorafenib