Böbrek Tümörlerinde Biyokimyasal Belirteçler
Özet
Böbrek tümörleri, %40 gibi yüksek bir oranla en ölümcül ürolojik kanser türü olup, prognozunun öngörülmesi tedavi planlaması açısından kritik önem taşır. Doğal seyri hastadan hastada değişen bu hastalıkta; anatomik, histolojik, klinik ve moleküler prognostik faktörler ele alınmaktadır. Birçok moleküler ve genetik faktör araştırılsa da, maliyet ve pratiklik açısından güncel rehberlerdeki prognostik modellerde biyokimyasal belirteçler öne çıkmaktadır. IMDC ve MSKCC gibi sistemlerde de yer bulan hemoglobin düşüklüğü (anemi) ile kalsiyum yüksekliği (hiperkalsemi), agresif seyir ve kötü sağkalım göstergeleridir. Tümör gelişimi ve metastaz süreçlerinde rol oynayan pro-tümöral inflamasyonun takibinde nötrofil-lenfosit (NLO) ve trombosit-lenfosit (TLO) oranlarının yüksekliği, total ve nükssüz sağkalımda kötü prognoza işaret eder. Ayrıca düşük lenfosit-monosit oranı, hücre yıkımıyla artan laktat dehidrojenaz (LDH) enzimi, sistemik inflamasyon belirteci C-reaktif protein (CRP) ve düşük albümin seviyeleri kötü sağkalım ile ilişkilidir. Kısıtlı literatüre sahip De ritis (AST/ALT) oranı ve non-spesifik nitelikteki sedimentasyon hızı da agresiflikle ilişkili diğer belirteçlerdir. Sonuç olarak; ucuz ve erişilebilir olan hemoglobin, kalsiyum, nötrofil, trombosit ve LDH gibi biyokimyasal parametreler, klinik pratikte böbrek tümörlerinin takibinde başarıyla kullanılmaktadır.
Kidney tumors represent the most lethal urological cancer with a high mortality rate of forty percent, making prognostic prediction critical for treatment planning. In this disease, whose natural course varies among patients, anatomical, histological, clinical, and molecular prognostic factors are evaluated. Although numerous molecular and genetic factors are investigated, biochemical markers stand out in current prognostic models within guidelines due to cost and practicality. Low hemoglobin (anemia) and elevated calcium (hypercalcemia), which are also included in systems like IMDC and MSKCC, indicate an aggressive course and poor survival. In monitoring pro-tumoral inflammation involved in tumor progression and metastasis, high neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios point to poor prognosis in overall and recurrence-free survival. Additionally, a low lymphocyte-to-monocyte ratio, lactate dehydrogenase (LDH) enzyme increasing with cell destruction, C-reactive protein (CRP) as a systemic inflammation marker, and low albumin levels are associated with poor survival. The De ritis (AST/ALT) ratio, which has limited literature, and the non-specific erythrocyte sedimentation rate are other markers associated with aggressiveness. Consequently, cheap and accessible biochemical parameters such as hemoglobin, calcium, neutrophils, platelets, and LDH are successfully utilized in clinical practice for monitoring kidney tumors.
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