Hepatosellüler karsinomda aspirin kullanımının survey üzerine etkisi /
Yazar: HAKAN AKTAN
Danışman: ÖĞR. GÖR. ÜMİT KARAOĞULLARINDAN
Çukurova Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı / Gastroenteroloji ve Hepatoloji Bilim Dalı
Derece: Tıpta Uzmanlık, 2022
Konu: Gastroenteroloji = Gastroenterology
Dizin: Aspirin = Aspirin ; Karaciğer hastalıkları = Liver diseases ; Karaciğer neoplazmları = Liver neoplasms ; Karsinoma = Carcinoma ; Karsinoma-hepatoselüler = Carcinoma-hepatocellular ; Neoplazmlar = Neoplasms ; Survey = Survey

Özet:
Amaç: Bu çalışmada aspirin kullanan HSK hastalarında, aspirin kullanımının survey üzerine
olan etkisini incelemeyi amaçladık.
Gereç ve Yöntem: Çalışmamız Ocak 2014 – Ocak 2022 yılları arasında Çukurova Üniversitesi Tıp Fakültesi hastanesine başvuran HSK tanılı hastalarla gerçekleştirildi. Toplamda 540 hasta incelendi ve dahil edilme kriterlerini karşılayan 300 hasta çalışmaya alındı.
Bulgular: Çalışmamıza dahil edilen toplam 300 hastanın 104'ü (%34.6) aspirin kullanırken, 196 hasta (%65.4) aspirin kullanmıyordu. Her iki grupta da belirgin erkek dominansı mevcut olup (sırasıyla %79.6 ve %80.8), gruplar arasında fark izlenmedi (p=0.808). Etyolojik faktörler açısından her iki grupta da en sık neden Hepatit B olarak izlendi. Sirotik zemin açısından, gruplar arasında anlamlı farklılık izlenmedi (p=0.978). Komorbid hastalıklar açısından değerlendirildiğinde diabetes mellitus ve hipertansiyon sıklığı açısından gruplar arasında farklılık izlenmedi (p:0.430, p:0.793). Koroner arter hastalığı ve hiperlipidemi sıklığı aspirin kullanan grupta anlamlı derecede fazlaydı (p<0.05).
Sonuç: Yaşam süreleri açısından değerlendirildiğinde, aspirin kullanan hasta grubunda yaşam süresinin anlamlı derecede yüksek olduğu izlendi (p=0.001).

Abstract:
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, originating from hepatocytes, which are epithelial cells of the liver. It constitutes approximately 90% of primary liver cancers. The incidence of HCC has been increasing in recent years. It usually occurs in the presence of chronic liver disease and cirrhosis, however, HCC can develop in non-cirrhotic livers (eg, NASH)
Viral hepatitis is the most important factor in hepatocellular carcinoma etiology. In the development of hepatocellular carcinoma; first, inflammation develops, followed by necrosis, fibrosis, and regeneration, respectively. Fibrosis and regeneration are the most important pathophysiological indicators of cirrhosis. Dysplastic nodule, early HCC and absolute HCC develop respectively from regeneration nodules.
After the diagnosis of HCC , staging is required for appropriate treatment selection. The choice of treatment is determined by the patient.
Although it is more common in men than women, the male/female ratio is approximately 3:1. In low-risk populations such as the USA, Canada. It is seen in older ages such as 75 years and older. However, a similar pattern is seen in many high-risk Asian populations. In high-risk African populations, it peaks between the ages of 60-65 in men and between the ages of 65-70 in women.
Hepatocarcinogenesis; occurs as a result of one and/or more multi-step mechanisms at the cellular and molecular levels. The transformation of hepatocytes into malignant cells as a result of molecular and histological changes is a multistep process. Although the gold standard diagnosis of the tumor is histopathology, it can be diagnosed non-invasively with the imaging and laboratory methods developed recently.
In patients diagnosed with hepatocellular carcinoma, clinical staging must be performed to assess prognosis and plan treatment. For staging; many staging systems have been used, such as Okuda staging system, Tumor-Node-Metastasis (TNM) system, Liver Cancer Italian Program (CLIP), Barcelona Clinical Liver Cancer (BCLC).
Treatment options can be listed as: liver transplant, Radiofrequency ablation, microwave ablation and cryoablation, Percutaneous ethanol or acetic acid ablation, Irreversible electroporation, Transarterial chemoembolization (TAKE), Transarterial radioembolization (TARE), Radiation therapy and stereotactic radiation therapy, Systemic chemotherapy with cytotoxic agents and molecular targeted therapies, Immunotherapy
HCC is an inflammation-related cancer. Chronic inflammation occurs as a result of vicious cycles of hepatocyte damage, inflammation, necrosis, and regeneration that cause fibrosis, cirrhosis, and genomic instability. This necro-inflammatory process in the liver; platelets promote the accumulation of inflammatory and immune cells.
The proinflammatory COX-2 enzyme is overexpressed in activated hepatic stellate cells and in inflammatory cancers including hepatocellular carcinoma. COX-2 overexpression activates profibrotic and proliferative signaling cascades, including protein kinase 3, nuclear factor κB pathways. Selective COX-2 inhibition reduces liver fibrosis, portal hypertension and proliferation of liver cancer cells.
We have seen that patients using aspirin have a longer life expectancy, although they are older and have more comorbid diseases.When evaluated in terms of bleeding, it was observed that all bleedings in the aspirin group were acute erosive gastritis or mucosal bleeding. Varicose bleeding was not observed in the aspirin group. No bleeding-related mortality was observed.