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Küçük Hücreli Dışı Akciğer Kanserinde Klinik ve Patolojik Evrelemenin Karşılaştırılması

Year 2011, Volume: 44 Issue: 1, 12 - 17, 01.04.2011

Abstract

Purpose: The aim of this study is to compare the clinical and the pathological staging results and to evaluate the value of clinical staging methods. Patients and Methods: Between January 2005 and January 2009, a total of 402 patients (365 male, 37 female) were operated with non-small cell lung cancer (NSCLC), were evaluated. The patients who received neoadjuvant therapy, having N2 or N3 disease proven by mediastinoscopy or having distant metastatic disease, patients without lymph node dissection or sampling were excluded from the study. All patients underwent CT, and 103 patients underwent PET-CT. Mediastinoscopy was performed 80 patients. All the specimens were examined histopathologically and staging was done according to these results. Results: The mean age was 61.36 ± 9.71. The most common type was squamous cell carcinoma in males (%54.2) and adenocarcinoma in females ( %73). The accuracy of thorax CT was %70 in the staging of T factor. The highest complaince between clinically and pathological results was seen in the T2 factor (% 79.2) and the lowest was in T4 factor (% 31.8). The accuracy of thorax CT was 74%, accuracy of PET-CT was 89% in N factor. When T and N factors are evaluated together, the highest complaince between clinically and pathological results was in stage Ib (61.3%) where it was 54.4% in all the study population. Conclusion: By the usage of non-invasive and invasive methods, only 50% of the non-small cell lung cancer patients are staged correctly. For NSCLC the best staging is achieved by operative findings and mediastinal lymph node dissection.

References

  • Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997; :1710-1717.
  • American Cancer Society. Cancer Facts and Figures, 1995. Atlanta: American Cancer Society:1995.
  • Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: Chest. 2003;123:1378-146S.
  • Chang MY, Sugarbaker DJ. Surgery for early stage non-small cell lung cancer. _ — Birim O, Kappetein AP, Waleboer M, Puvimanasinghe JP, Eijkemans MJ, Steyerberg EW et al. Long-term survival after non-small cell lung cancer surgery: development and validation of a prognostic model With a preoperative and postoperative mode. J Thorac Cardiovasc Surg. ; 132: 491-498. Toloza EM, Harpole L, Detterbeck F, McCrory DC. Invasive staging of non-small cell lung cancer: Chest. 2003;123:1578-166S.
  • Yurdakul AS, Çalışır HC, Demirağ F, Taci N, Öğretensoy M. Akciğer Kanserinin Histolojik Tiplerinin Dağılımı. Toraks Dergisi 2002; 3,.59-65.
  • Lopez-Encuentra A, Garcia-Lujan R, Rivas JJ, Rodriguez-Rodriguez J, Torres-Lanza J, Varela—Simo G; Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery. Ann Thorac Surg. 2005; 79: 974-979
  • Vaporciyan AA, Merriman KW, Ece F, Roth JA, Smythe WR, Swisher SG et al. Incidence of major pulmonary morbidity after pneurnonectomy: association with timing of smoking cessation. Ann Thorac Surg. 2002;73:420-6.
  • Üçvet A, Kul C, Ceylan KC, Yuncu G, Sevinç S, Tözüm H ve ark: Pnömonektomi Endikasyonu ve Sonuçları: Solunum 2008; 10:19-23.
  • Sioris T, Jârvenpââ R, Kuukasjârvi P, Helin H, Saarelainen S, Tarkka M. Comparison of computed tomography and systematic lymph node dissection in determining TNM and stage in non-small cell lung cancer. Eur J Cardiothorac Surg. 2003; 23: 403-408.
  • ' Cetinkaya E, Turna A, Yildiz P, Dodurgali R, Bedirhan MA, Gürses A et al. Comparison of clinical and surgical-patholgical staging of the patients With non-small cell lung carcinoma. Gdedo A, Van Schil PV, Corthouts B, Mieghem FV, Meerbeeck JV, Marck EV. Comparison of imaging TNM [(i) TNM] and pathological TNM [(p) TNM] in staging of bronchogenic carcinoma. Eur J Cardiothorac Surg 1997; 12: 224-227. lşıtmangil T, Balkanlı K. Akciğer kanserinin evrelendirilmesi. Göğüs Cerrahisi, Yüksel
  • M, Kalaycı NG, ed. İstanbul 2001:161-202.
  • Quint LE, Francis IR. Radiologic staging of lung cancer. J Thorac Imaging. 1999; 14: 5-246.
  • Venuta F, Rendina EA, Ciriaco P, Polettini E, Di Biasi C, Gualdi GF, et al. Computed tomography for preoperative assessment of T3 and T4 bronchogenic carcinoma. _ _ Vesselle H, Pugsley JM, Vallieres E, Wood DE. The impact of İluorodeoxyglucose F 18 positron-emission tomography on the surgical staging of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2002;124: 511-519.
  • Apolinario RM, van der Valk P, de Jong JS, Deville W, van Ark-Otte J, Dingemans AM et al. Prognostic value of the expression of p53, bcl-2, and bax oncoproteins, and neovascularization in patients with radically resected non-small-cell lung cancer. J Clin Oncol. 1997;15: 2456-2466.
  • Dales RE, Stark RM, Raman S. Computed tomography to stage lung cancer. Approaching a controversy using meta-analysis. Am Rev Respir Dis. 1990;141:1096-1101.
  • Shields TW. The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. A commentary. J Thorac Cardiovasc Surg. ; 99: 48-53. Johnston MR. Invasive staging of the mediastinum.World J Surg. 1993;17:700-704
  • Steinert HC, Hauser M, Allemann F, Engel H, Berthold T, von Schulthess GK et al. Non- small cell lung cancer: nodal staging With FDG PET versus CT with correlative lymph node mapping and sampling. Radiology. 1997; 202: 441-446.
  • Cerfolio RJ, tha B, Mukherjee S, Pask AH, Bass CS, Katholi CR. Positron emission tomography scanning With 2-fluoro-2-deoxy-d-glucose as a predictor of response of neoadjuvant treatment for non-small cell carcinoma. J Thorac Cardiovasc Surg. 2003; 125: 8-944.
  • Goldsmith SJ, Kostakoglu LA, Somrov S, Palestro CJ. Radionuclide imaging of thoracic malignancies. Thorac Surg Clin. 2004; 14: 95-112.
  • Tablo 1. Operasyonda uygulanan rezeksiyon tipleri Pnömonektomi Lobektomi Wedge Eksploratris Segmentektomi rezeksiyon torakotomi n(%) n (%) n(%) n(%) n (%) Sağ 36(8.9) 183 (45.5) 6(1.5) 6(1.5) 2(0.5) Sol 41(10.2) 117(29.1) 5(1.2) 6(1.5) - Toplam 77 (19.1) 300(74.6) 11(2.7) 12(2.9) 2(0.5)

Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer

Year 2011, Volume: 44 Issue: 1, 12 - 17, 01.04.2011

Abstract

Amaç: Operasyon uygulanan küçük hücreli dışı akciğer kanserli (KHDAK) olgularda klinik ve patolojik evrelerin karşılaştırılarak klinik evreleme yöntemlerinin KHDAK evrelemesindeki etkinliğinin araştırılması amaçlandı. Hastalar ve Yöntem: Ocak 2005 - Ocak 2009 tarihleri arasında opere edilen 365'i erkek 37'si kadın toplam 402 KHDAK tanılı olgu değerlendirildi. Neoadjuvan tedavi uygulanan, mediastinoskopide N2 veya N3 saptanan, lenf nodu örneklemesi veya sistematik lenf nodu diseksiyonu yapılmayanlar ile uzak metastazı olan olgular çalışma dışı bırakıldı. Non-invaziv evreleme toraks bilgisayarlı tomografi (BT) ve 103 olguya pozitron emisyon tomografisi (PET-BT) ile yapıldı. Mediastinoskopi 80 hastaya uygulandı. Operasyonda alınan tüm materyaller histopatolojik olarak incelenerek patolojik evreleme yapıldı. Bulgular: Yaş ortalaması 61.36±9.71 idi. Erkeklerde en sık (%54.2) skuamöz hücreli karsinom, kadınlarda ise adenokarsinoma (%73) saptandı. BT'nin T faktöründe doğruluk oranı %70 olarak bulundu. En iyi uyum %79.2 ile T2'nin değerlendirilmesinde, en düşük uyum %31.8 ile T4'de bulundu. N faktöründe doğruluk oranı BT'nin %74, PET-BT'nin ise %89 idi. T,N faktörleri birlikte değerlendirildiğinde; klinik ve patolojik uyum en iyi evre Ib olgularında %61.3 iken tüm olguların klinik ve patolojik uyumu %54.4 bulundu. Sonuç: Noninvaziv ve invaziv yöntemler kullanılsa bile olguların ancak yarısı doğru evrelendirilmektedir. KHDAK olgular için en iyi evreleme operasyon bulguları ve mediastinal lenf bezi diseksiyonu ile olabilmektedir.

References

  • Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997; :1710-1717.
  • American Cancer Society. Cancer Facts and Figures, 1995. Atlanta: American Cancer Society:1995.
  • Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: Chest. 2003;123:1378-146S.
  • Chang MY, Sugarbaker DJ. Surgery for early stage non-small cell lung cancer. _ — Birim O, Kappetein AP, Waleboer M, Puvimanasinghe JP, Eijkemans MJ, Steyerberg EW et al. Long-term survival after non-small cell lung cancer surgery: development and validation of a prognostic model With a preoperative and postoperative mode. J Thorac Cardiovasc Surg. ; 132: 491-498. Toloza EM, Harpole L, Detterbeck F, McCrory DC. Invasive staging of non-small cell lung cancer: Chest. 2003;123:1578-166S.
  • Yurdakul AS, Çalışır HC, Demirağ F, Taci N, Öğretensoy M. Akciğer Kanserinin Histolojik Tiplerinin Dağılımı. Toraks Dergisi 2002; 3,.59-65.
  • Lopez-Encuentra A, Garcia-Lujan R, Rivas JJ, Rodriguez-Rodriguez J, Torres-Lanza J, Varela—Simo G; Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery. Ann Thorac Surg. 2005; 79: 974-979
  • Vaporciyan AA, Merriman KW, Ece F, Roth JA, Smythe WR, Swisher SG et al. Incidence of major pulmonary morbidity after pneurnonectomy: association with timing of smoking cessation. Ann Thorac Surg. 2002;73:420-6.
  • Üçvet A, Kul C, Ceylan KC, Yuncu G, Sevinç S, Tözüm H ve ark: Pnömonektomi Endikasyonu ve Sonuçları: Solunum 2008; 10:19-23.
  • Sioris T, Jârvenpââ R, Kuukasjârvi P, Helin H, Saarelainen S, Tarkka M. Comparison of computed tomography and systematic lymph node dissection in determining TNM and stage in non-small cell lung cancer. Eur J Cardiothorac Surg. 2003; 23: 403-408.
  • ' Cetinkaya E, Turna A, Yildiz P, Dodurgali R, Bedirhan MA, Gürses A et al. Comparison of clinical and surgical-patholgical staging of the patients With non-small cell lung carcinoma. Gdedo A, Van Schil PV, Corthouts B, Mieghem FV, Meerbeeck JV, Marck EV. Comparison of imaging TNM [(i) TNM] and pathological TNM [(p) TNM] in staging of bronchogenic carcinoma. Eur J Cardiothorac Surg 1997; 12: 224-227. lşıtmangil T, Balkanlı K. Akciğer kanserinin evrelendirilmesi. Göğüs Cerrahisi, Yüksel
  • M, Kalaycı NG, ed. İstanbul 2001:161-202.
  • Quint LE, Francis IR. Radiologic staging of lung cancer. J Thorac Imaging. 1999; 14: 5-246.
  • Venuta F, Rendina EA, Ciriaco P, Polettini E, Di Biasi C, Gualdi GF, et al. Computed tomography for preoperative assessment of T3 and T4 bronchogenic carcinoma. _ _ Vesselle H, Pugsley JM, Vallieres E, Wood DE. The impact of İluorodeoxyglucose F 18 positron-emission tomography on the surgical staging of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2002;124: 511-519.
  • Apolinario RM, van der Valk P, de Jong JS, Deville W, van Ark-Otte J, Dingemans AM et al. Prognostic value of the expression of p53, bcl-2, and bax oncoproteins, and neovascularization in patients with radically resected non-small-cell lung cancer. J Clin Oncol. 1997;15: 2456-2466.
  • Dales RE, Stark RM, Raman S. Computed tomography to stage lung cancer. Approaching a controversy using meta-analysis. Am Rev Respir Dis. 1990;141:1096-1101.
  • Shields TW. The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. A commentary. J Thorac Cardiovasc Surg. ; 99: 48-53. Johnston MR. Invasive staging of the mediastinum.World J Surg. 1993;17:700-704
  • Steinert HC, Hauser M, Allemann F, Engel H, Berthold T, von Schulthess GK et al. Non- small cell lung cancer: nodal staging With FDG PET versus CT with correlative lymph node mapping and sampling. Radiology. 1997; 202: 441-446.
  • Cerfolio RJ, tha B, Mukherjee S, Pask AH, Bass CS, Katholi CR. Positron emission tomography scanning With 2-fluoro-2-deoxy-d-glucose as a predictor of response of neoadjuvant treatment for non-small cell carcinoma. J Thorac Cardiovasc Surg. 2003; 125: 8-944.
  • Goldsmith SJ, Kostakoglu LA, Somrov S, Palestro CJ. Radionuclide imaging of thoracic malignancies. Thorac Surg Clin. 2004; 14: 95-112.
  • Tablo 1. Operasyonda uygulanan rezeksiyon tipleri Pnömonektomi Lobektomi Wedge Eksploratris Segmentektomi rezeksiyon torakotomi n(%) n (%) n(%) n(%) n (%) Sağ 36(8.9) 183 (45.5) 6(1.5) 6(1.5) 2(0.5) Sol 41(10.2) 117(29.1) 5(1.2) 6(1.5) - Toplam 77 (19.1) 300(74.6) 11(2.7) 12(2.9) 2(0.5)
There are 20 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Kenan Can Ceylan This is me

Ali Hızır Arpat This is me

Şeyda Örs Kaya This is me

Publication Date April 1, 2011
Published in Issue Year 2011 Volume: 44 Issue: 1

Cite

APA Ceylan, K. C. ., Arpat, A. H. ., & Kaya, Ş. Ö. . (2011). Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer. Acta Oncologica Turcica, 44(1), 12-17.
AMA Ceylan KC, Arpat AH, Kaya ŞÖ. Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer. Acta Oncologica Turcica. April 2011;44(1):12-17.
Chicago Ceylan, Kenan Can, Ali Hızır Arpat, and Şeyda Örs Kaya. “Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer”. Acta Oncologica Turcica 44, no. 1 (April 2011): 12-17.
EndNote Ceylan KC, Arpat AH, Kaya ŞÖ (April 1, 2011) Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer. Acta Oncologica Turcica 44 1 12–17.
IEEE K. C. . Ceylan, A. H. . Arpat, and Ş. Ö. . Kaya, “Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer”, Acta Oncologica Turcica, vol. 44, no. 1, pp. 12–17, 2011.
ISNAD Ceylan, Kenan Can et al. “Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer”. Acta Oncologica Turcica 44/1 (April 2011), 12-17.
JAMA Ceylan KC, Arpat AH, Kaya ŞÖ. Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer. Acta Oncologica Turcica. 2011;44:12–17.
MLA Ceylan, Kenan Can et al. “Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer”. Acta Oncologica Turcica, vol. 44, no. 1, 2011, pp. 12-17.
Vancouver Ceylan KC, Arpat AH, Kaya ŞÖ. Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer. Acta Oncologica Turcica. 2011;44(1):12-7.