Procjena oštećenja bubrežne funkcije i kvalitete života bolesnika nakon poslijeoperacijske radiokemoterapije zbog karcinoma želuca

Skoblar Vidmar, Marija (2019) Procjena oštećenja bubrežne funkcije i kvalitete života bolesnika nakon poslijeoperacijske radiokemoterapije zbog karcinoma želuca. PhD thesis, Sveučilište u Zagrebu.

[img] PDF
Download (2MB)

Abstract

PREAMBLE: Postoperative radiochemotherapy after surgical procedure greatly enhances overall survival and locoregional control of the disease in patients with adenocarcinoma of the stomach in the stage IB to IIIC of the disease. The acute consequences of such treatment methods are well known and successfully controlled with supporting therapy, while the later consequences are relatively indistinct, especially damage to kidney function. ----- STUDY GOAL: We have tried to assess the resulting damage to kidney function according to various formulas used to calculate GFR and define the incidence, occurrence dynamics and the stages of the damage. We were interested in the quality of patients' lives, as well as whether there was any connection between the patient's quality of life and the stage of the damage to kidney function. ----- STUDY PARTICIPANTS AND METHODS: The research has been conceived as a prospective cohort clinical study. It was carried out at the Institute of Oncology in Ljubljana, Radiotherapy Division. The subjects were brought into the study in the period from November 2009 leading up to March 2013. In total 118 patients were involved in the study. The period of monitoring following the end of the oncology treatment amounted to 5 years and consisted of 7 control examinations. Standardized EORTC QLQ C 30 questionnaire assessing the quality of patients' lives had been filled in prior to the post-operative radiochemotherapy and later during 3 control examinations (after the first, third and fifth year). ----- RESULTS: The estimated GFR level at the final control five years after the end of the oncology treatment was statistically significantly lower in comparison to the values prior to the adjuvant treatment, regardless of the formula used to calculate it. Statistically, the lowest results were obtained by calculating the eGFR according to the CG formula, and the average value at the final control examination was 71.2 ml /min / 1.73 m2. At the last control examination, 33.4 % patients displayed eGFR value lower than 60 ml/min /1.73 m2 according to the CG formula, 20 % patients according to the CKD- EPI formula and 17.7 % according to the MDRD formula. The most sensitive dose-volume parameter that can point to developing damage to kidney function is V12 Gy for a bilateral kidney that in our study amounted to 54 %. Statistical analysis of standardized EORTC QLQ C 30 questionnaires showed a significant rise in the general health condition and quality of our patients' lives when compared to the previous control examination. The damage to kidney function is clinically irrelevant and therefore has no bearing on the quality of life. The analysis of survival rate showed that all the patients died due to the progress of the underlying disease and that the overall survival (OS) is equal to the disease-specific survival (DSS) and amounted to 60.7 % The disease-free survival (DFS) amounted to 60.3 %. Locoregional control (LRC) amounted to 81.6 %. ----- CONCLUSION: Following the post-operative treatment with capecitabine, damage to kidney function and chronic kidney disease develop. The influence of kidney damage on the quality of life has not been proven. It is vital that the damage is revealed in the early stages of the kidney disease because changes in the way of life and renoprotective drugs can inhibit the progress of the disease into later stages. Due to the progressive character of radiation nephropathy, it is necessary to continue the systematic monitoring of these patients. Standardized EORTC questionnaire QLQ C30 represents a simple and economical manner of screening potential damage to many physical and psychological functions that require further multidisciplinary treatment.

Abstract in Croatian

UVOD: Poslijeoperacijska radiokemoterapija nakon radikalnog kirurškog zahvata poboljšava cjelokupno preživljenje i lokoregionalnu kontrolu bolesti u bolesnika s adenokarcinomom želuca u stadiju bolesti od IB do IIIC. Akutne posljedice ovakvog načina liječenja dobro su poznate te ih potpornom terapijom uspješno kontroliramo, dok se o kasnim posljedicama, osobito o oštećenju bubrežne funkcije, zna vrlo malo. ----- CILJ ISTRAŽIVANJA: Željeli smo procijeniti nastalo oštećenje bubrežne funkcije prema različitim formulama za računanje GF te definirati incidenciju, dinamiku pojavljivanja i stadije oštećenja. Zanimalo nas je i kakva je kvaliteta života ovih bolesnika te postoji li povezanost između kvalitete života bolesnika i stupnja oštećenja bubrežne funkcije. ----- ISPITANICI I METODE: Istraživanje je osmišljeno kao prospektivna kohortna klinička studija. Provodilo se na Onkološkom institutu u Ljubljani, u sektoru Radioterapije. Ispitanike smo uključivali u istraživanje od studenog 2009. godine do ožujka 2013. godine. U istraživanje smo uključili 118 bolesnika. Period praćenja nakon završenog onkološkog liječenja je trajao 5 godina (60 mjeseci) i ukupno je bilo 7 kontrolnih pregleda. Standardizirani EORTC QLQ C 30 upitnik kojim smo ocjenjivali kvalitetu života bolesnika je bio popunjavan prije početka poslijeoperacijske radiokemoterapije i kasnije tijekom 3 kontrolna pregleda ( nakon 1., 3 i 5. godine). ----- REZULTATI: eGFR je na zadnjoj kontroli pet godina nakon završenog onkološkog liječenja bila statistički značajno niža u odnosu na vrijednosti prije početka adjuvantnog liječenja bez obzira na formulu kojom je izračunata. Statistički najslabiji rezultati su dobiveni računajući eGFR po CG formuli te je prosječna vrijednost na zadnjoj kontroli iznosila 71.2 ml/min/1.73 m2. Na zadnjoj kontroli je eGFR nižu od 60 ml/min/1.73 m2 prema CG formuli imalo 33.4 % bolesnika, prema CKD- EPI formuli 20 % bolesnika te prema MDRD formuli 17.7 % bolesnika. Najosjetljiviji dozno volumni parametar koji može predvidjeti razvoj oštećenja bubrežne funkcije je V12 Gy za bilateralni bubreg koji je u našem istraživanju iznosio 54 %. Statističkom analizom standardiziranih EORTC QLQ C 30 upitnika utvrđeno je da opće zdravstveno stanje i kvaliteta života naših bolesnika značajno rastu prema zadnjem kontrolnom pregledu. Nastalo oštećenja bubrežne funkcije je klinički irelevantno i, stoga, nije značajno utjecalo na kvalitetu života. Analizom preživljenja je utvrđeno da su svi bolesnici tijekom petogodišnjeg razdoblja umrli zbog progresije osnovne bolesti tako da je cjelokupno preživljenje (OS) jednako bolest specifičnom preživljenju (DSS) i iznosilo je 60.7 % Razdoblje bez bolesti (DFS) je iznosilo 60.3 %. Lokoregionalna kontrola (LRC) je iznosila 81.6 %. ----- ZAKLJUČAK: Nakon poslijeoperacijskog liječenja s kapecitabinom dolazi do oštećenja bubrežne funkcije i razvoja kronične bubrežne bolesti. Nije dokazan utjecaj bubrežnog oštećenja na kvalitetu života. Važno je otkrivanje oštećenja u ranijim stadijima bubrežne bolesti jer se promjenom načina života i renoprotektivnim lijekovima može usporiti napredovanje u kasnije stadije. Zbog progresivnog karaktera radijacijske nefropatije potrebno je nastaviti sa sustavnim praćenjem ovih bolesnika. Standardizirani EORTC upitnik QLQ C30 predstavlja jednostavan i ekonomičan način provjere mogućih oštećenja mnogih tjelesnih i psiholoških funkcija koja trebaju daljnju multidisciplinarnu obradu.

Item Type: Thesis (PhD)
Mentors:
Mentor
Bašić Jukić, Nikolina
Oblak, Irena
Departments: Izvan medicinskog fakulteta
Depositing User: Anja Majstorović
University: Sveučilište u Zagrebu
Institution: Medicinski fakultet
Number of Pages: 136
Status: Unpublished
Creators:
CreatorsEmail
Skoblar Vidmar, MarijaUNSPECIFIED
Date: 13 June 2019
Date Deposited: 14 Oct 2019 07:42
Last Modified: 14 Oct 2019 07:42
Subjects: /
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/3447

    Actions (login required)

    View Item View Item

    Downloads

    Downloads per month over past year