Erken Evre Meme Kanserinde Prognostik Faktörler
Özet
Erken evre meme kanserinde prognostik faktörlerin belirlenmesi, hastalığın biyolojik davranışını öngörmek, tedavi stratejilerini bireyselleştirmek ve sağkalım oranlarını optimize etmek açısından temel öneme sahiptir. Bu faktörler genel olarak hasta özellikleri, anatomik ve biyolojik değişkenler olmak üzere üç ana başlık altında incelenmektedir. Hasta özellikleri arasında yaş, ırk ve sigara kullanımı öne çıkmakta; özellikle genç (<35 yaş) ve ileri yaş (>70 yaş) gruplarında olumsuz prognoz gözlenmektedir. Siyahi ırkta agresif tümör alt tiplerinin, sigara içicilerde ise mortalite oranlarının daha yüksek olduğu gösterilmiştir. Anatomik faktörler arasında aksiller lenf nodu tutulumu, tümör boyutu, lenfovasküler invazyon ve histomorfolojik alt tipler yer almakta olup, ≥4 lenf nodu metastazı sistemik nüks riskini anlamlı şekilde artırmaktadır. Biyolojik prognostik göstergeler arasında histolojik derece, hormon reseptör durumu (ER/PR), HER2 aşırı ekspresyonu ve proliferasyon indeksi (Ki67) öne çıkmaktadır. Moleküler sınıflamada luminal A alt tipi en iyi, bazal (üçlü negatif) alt tip ise en kötü prognozla ilişkilidir. Tüm bu faktörlerin entegre değerlendirilmesi, optimal adjuvan tedavi planlaması ve uzun dönem sağkalımın artırılması açısından kritik klinik değere sahiptir.
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