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KÜÇÜK HÜCRELİ DIŞI AKCİĞER KANSERİ BAŞLANGIÇ EVRELEMESİNDE KLİNİK DEĞERLENDİRME VE LABORATUVAR İLİŞKİSİ

Year 2010, Volume: 24 Issue: 1, 1 - 13, 01.05.2010

Abstract

Küçük hücre dışı akciğer kanseri (KHDAK) tanısı alan hastalarda epidemiyolojik, klinik, laboratuar, görüntüleme bulgularının, ileri evreyi ve metastaz varlığını öngörmedeki değerinin araştırılması amaçlanmıştır. Araştırma, Ocak 2006 ve Mart 2007 tarihleri arasında KHDAK tanısı alan 112'si erkek, 8'i kadın olmak üzere toplam 120 hasta ile gerçekleştirildi. Hastaların organa spesifik bulguları ve organ spesifik olmayan bulguları sorgulandı. Hastaların TNM evresi; kontrastlı toraks bilgisayarlı tomografisi (BT) ve fiberoptik bronkoskopi (FOB) ile, uluslararası TNM evreleme sistemi kullanılarak belirlendi. Uzak organ metastaz taraması beyin BT, kemik sintigrafisi ve batın ultrasonografisi (USG) ile yapıldı. Histopatolojik alt tip ve ECOG performans skoru ile ileri evre arasında istatistiksel olarak anlamlı bir fark saptanmadı (p>0.05). Organ spesifik semptomlardan herhangi biri ile ke mik ve beyin metastazı arasında istatistiksel olarak anlamlılık bulunurken, karaciğer metastazı arasında ise anlamlı bir fark saptanmadı. Nonspesifik semptom ve bulgulardan herhangi biri ile (ses kısıklığı, vena kava süperior sendromu (VCSS), hipoalbuminemi, anemi, trombositoz) sırasıyla kemik, karaciğer, beyin metastazı arasında istatistiksel olarak anlamlı bir fark bulunmadı. T3-4 faktörü ile kemik, beyin, karaciğer metastazı arasında sayısal olarak anlamlılık bulunurken istatistiksel olarak anlamlı bir fark saptanmadı N1-2-3 faktörü ile kemik, beyin, karaciğer metastazı arasında da istatistiksel olarak anlamlı bir fark saptanmadı ancak N2 grubunda metastaz sayılarının daha fazla olduğu görüldü. T ve N grupları herhangi bir organ metastazı açısından değerlendirildiğinde istatistiksel olarak anlamlı bir fark saptanmadı. Sonuç olarak KHDAK hastalarında ileri evreyi öngören belirgin nonspesifik semptom ve bulgu saptanmamasına rağmen, özellikle organ spesifik semptom ve bulguların değerlendirilmesinin, metastazları öngörmede yardımcı olabileceği görülmüştür ancak bu konuda, daha geniş hasta grupları ile yapılacak, daha fazla sayıda prospektif çalışmalara ihtiyaç vardır.

References

  • 1. Spiro SG, Porter JC: Lung cancer-Where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med 2002; 166: 1166-96.
  • 2. Turkish Thoracic Society, Lung and Pleural Malignancies Study Group. Pattern of lung cancer in Turkey 1994-1998. Respiration 2002; 69: 207-10.
  • 3. Kubik A, Haerting J. Survival and mortality in a randomized study of lung cancer detection. Neoplasma 1990; 37: 467-75.
  • 4. Silvestri GA, Littenberg B, Colice GL. The clinical evaluation for detecting metastatic lung cancer: A meta-analysis. Am J Respir Crit Care Med 1995; 152: 225-30.
  • 5. Hooper RG, Tenholder MF, Underwood GH, et al. Computed tomographic scanning in initial stating of bronchogenic carcinoma. Chest 1984; 85(6): 774-6.
  • 6. Alpar S, Uçar N, Turgut A, ve ark.Akci_er kanseri hastalarda uzak metastaz ile organa özgül semptomlar› iliflkisi. Tüberküloz ve Toraks 2004; 52: 14-8.
  • 7. Bilgin S, Y›lmaz A, Özdemir F, ve ark. Extrathoracic staging of non-small cell bronchogenic carcinoma: Relationship of the clinical evaluation to organ scans. Respirology 2002; 7: 57-61.
  • 8. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997; 111: 1710-7.
  • 9. Scagliotti G. Symptoms, signs and staging of lung cancer. Eur Respir Mon 2001; 17: 86- 119.
  • 10. Grant D, Edwards D, Goldstraw P. Computed tomography of the brain, chest and abdomen in the preoperative assessment of non-small cell lung cancer. Thorax 1988; 43(11): 883-6.
  • 11. Ramsdell JW, Peters RM, Taylor AT, et al. Multi organ scans of staging lung cancercorrelation with clinical evaluation. J Thorac Cardiovasc Surg 1977; 73: 653-9.
  • 12. Michel F, Soler M, Imhof E, Perruchoud AP. Initial staging of non-small cell lung cancer: value of routine radioisotope bone scanning. Thorax 1991; 46: 469-73.
  • 13. Cole FH, Thomas JE, Wilcox AB, Halford HH. Cerebral imaging in the asymptomatic preoperative bronchogenic carcinoma patients: Is it worthwhile? Ann Thorac Surg 1994; 57: 838-40.
  • 14. Canadian Lung Oncology Group. Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer. Ann Thorac Surg 2001; 71: 425-34.
  • 15. Earnest IF, Ryu JH, Miller GM, et al. Suspected non-small cell lung cancer: incidence of occult brain and skeletal metastases and effectiveness of imaging for detection-pilot study. Radiology 1999; 211: 137-45.
  • 16. Kormas P, Bradshaw JR, Jeyasingham K. Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma. Thorax 1992; 47:106-8.
  • 17. Ferrigno D, Buccheri G. Cranial computed tomography as a part of the initial staging procedures for patients with non-small cell lung cancer. Chest 1994; 106: 1025-9.
  • 18. Sandler MA, Pearlberg JL, Madrazo BL, et al. Computed tomographic evaluation of the adrenal gland in the preoperative assessment of bronchogenic carcinoma. Radiology 1982; 145: 733-6.
  • 19. Chapman GS, Kumar D, Redmond J, et al. Upper abdominal computerized tomography scanning in staging non-small cell lung carcinoma. Cancer 1984; 54: 1541-3.
  • 20. Salvatierra A, Baamonde C, Liamas JM, et al. Extrathoracic staging of bronchogenic carcinoma. Chest 1990; 97: 1052-8.
  • 21. Quinn DL, Ostrow LB, Porter DK, et al. Staging of non-small cell bronchogenic carcinoma. Relationship of the clinical evaluation to organ scans. Chest 1986; 89(2): 270-5.
  • 22. Tammemagi CM, Neslund-Dudas C, Simoff M, et al. Lung carcinoma symptoms-an independent predictor of survival and an important mediator of African-American disparity in survival. American Cancer Society 2004; 101: 1655-63.
  • 23. Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non small cell lung cancer: a review of the current evidence. Chest 2003; 123: 137-46.
  • 24. Yurdakul A, Öztürk C, Taflk›n D. Akci¤er kanserli hastalarda akci¤er d›fl› metastaz ile klinik de¤erlendirmenin iliflkisi. Solunum 2006 ; 3(1): 9-13.
  • 25. fiahin ‹, Ak G, Metintafl M ve ark. Akci¤er kanserli hastalarda uzak metastaz da¤›l›m›, klinik özellikleri ve uzak metastazlar›n tayini. Osmangazi T›p Dergisi 2007; 29(1): 13-28.
  • 26. Tanaka K, Kubota K, Kodama T, et al. Extrathoracic staging is not necessary for nonsmall-cell lung cancer with clinical stag T1-2 N0. Ann Thorac Surg. 1999; 68(3): 1039-42.

THE CORRELATION OF CLINICAL JUDGEMENT AND LABORATORY ASSESSMENT IN THE INITIAL STAGING OF NONSMALL CELL LUNG CANCER

Year 2010, Volume: 24 Issue: 1, 1 - 13, 01.05.2010

Abstract

The objective of this study was to assess the value of clinical, laboratory, and radiological findings in predicting progressive and metastatic disease in patients with non-small cell lung cancer. We designed a prospective study including 120 patients (112 male, 8 female) followed between January 2006 and March 2007. Clinical organ specific symptoms and nonspecific symptoms were evaluated. TNM staging was performed by international TNM staging system, using thoracic computed tomography, bronchoscopy and PET/CT, when necessary. Distant metastasis were detected by brain/abdominal computed tomography, bone scintigraphy, and abdominal ultrasonography. There was no statistical difference between progressive disease and histological subtypes. Eastern Cooperative Oncology Group Performance States (ECOG, PS) also did not show significant difference in relation to progressive disease (p>0.05). Organ specific symptoms were significantly correlated with bone (p=0.01) and brain metastasis (p=0.01), whereas there was no relation with liver metastasis (p=1). There was also no significant relation between organ metastasis and nonspecific symptoms and findings such as VCSS, hypoalbuminemia, anemia and thrombocytosis. There was no statistically difference in bone, brain and liver metastasis between two groups, when T1 and T2 are grouped as one, and T3 and T4 are grouped as the other. The results were the same regarding the lymph node involvement, namely N1, N2 and N3. Determination of organ specific symptoms and findings might have predictive value in the evaluation of metastases in patients with nonsmall cell lung cancer. Further prospective studies with a larger group of patients are needed.

References

  • 1. Spiro SG, Porter JC: Lung cancer-Where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med 2002; 166: 1166-96.
  • 2. Turkish Thoracic Society, Lung and Pleural Malignancies Study Group. Pattern of lung cancer in Turkey 1994-1998. Respiration 2002; 69: 207-10.
  • 3. Kubik A, Haerting J. Survival and mortality in a randomized study of lung cancer detection. Neoplasma 1990; 37: 467-75.
  • 4. Silvestri GA, Littenberg B, Colice GL. The clinical evaluation for detecting metastatic lung cancer: A meta-analysis. Am J Respir Crit Care Med 1995; 152: 225-30.
  • 5. Hooper RG, Tenholder MF, Underwood GH, et al. Computed tomographic scanning in initial stating of bronchogenic carcinoma. Chest 1984; 85(6): 774-6.
  • 6. Alpar S, Uçar N, Turgut A, ve ark.Akci_er kanseri hastalarda uzak metastaz ile organa özgül semptomlar› iliflkisi. Tüberküloz ve Toraks 2004; 52: 14-8.
  • 7. Bilgin S, Y›lmaz A, Özdemir F, ve ark. Extrathoracic staging of non-small cell bronchogenic carcinoma: Relationship of the clinical evaluation to organ scans. Respirology 2002; 7: 57-61.
  • 8. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997; 111: 1710-7.
  • 9. Scagliotti G. Symptoms, signs and staging of lung cancer. Eur Respir Mon 2001; 17: 86- 119.
  • 10. Grant D, Edwards D, Goldstraw P. Computed tomography of the brain, chest and abdomen in the preoperative assessment of non-small cell lung cancer. Thorax 1988; 43(11): 883-6.
  • 11. Ramsdell JW, Peters RM, Taylor AT, et al. Multi organ scans of staging lung cancercorrelation with clinical evaluation. J Thorac Cardiovasc Surg 1977; 73: 653-9.
  • 12. Michel F, Soler M, Imhof E, Perruchoud AP. Initial staging of non-small cell lung cancer: value of routine radioisotope bone scanning. Thorax 1991; 46: 469-73.
  • 13. Cole FH, Thomas JE, Wilcox AB, Halford HH. Cerebral imaging in the asymptomatic preoperative bronchogenic carcinoma patients: Is it worthwhile? Ann Thorac Surg 1994; 57: 838-40.
  • 14. Canadian Lung Oncology Group. Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer. Ann Thorac Surg 2001; 71: 425-34.
  • 15. Earnest IF, Ryu JH, Miller GM, et al. Suspected non-small cell lung cancer: incidence of occult brain and skeletal metastases and effectiveness of imaging for detection-pilot study. Radiology 1999; 211: 137-45.
  • 16. Kormas P, Bradshaw JR, Jeyasingham K. Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma. Thorax 1992; 47:106-8.
  • 17. Ferrigno D, Buccheri G. Cranial computed tomography as a part of the initial staging procedures for patients with non-small cell lung cancer. Chest 1994; 106: 1025-9.
  • 18. Sandler MA, Pearlberg JL, Madrazo BL, et al. Computed tomographic evaluation of the adrenal gland in the preoperative assessment of bronchogenic carcinoma. Radiology 1982; 145: 733-6.
  • 19. Chapman GS, Kumar D, Redmond J, et al. Upper abdominal computerized tomography scanning in staging non-small cell lung carcinoma. Cancer 1984; 54: 1541-3.
  • 20. Salvatierra A, Baamonde C, Liamas JM, et al. Extrathoracic staging of bronchogenic carcinoma. Chest 1990; 97: 1052-8.
  • 21. Quinn DL, Ostrow LB, Porter DK, et al. Staging of non-small cell bronchogenic carcinoma. Relationship of the clinical evaluation to organ scans. Chest 1986; 89(2): 270-5.
  • 22. Tammemagi CM, Neslund-Dudas C, Simoff M, et al. Lung carcinoma symptoms-an independent predictor of survival and an important mediator of African-American disparity in survival. American Cancer Society 2004; 101: 1655-63.
  • 23. Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non small cell lung cancer: a review of the current evidence. Chest 2003; 123: 137-46.
  • 24. Yurdakul A, Öztürk C, Taflk›n D. Akci¤er kanserli hastalarda akci¤er d›fl› metastaz ile klinik de¤erlendirmenin iliflkisi. Solunum 2006 ; 3(1): 9-13.
  • 25. fiahin ‹, Ak G, Metintafl M ve ark. Akci¤er kanserli hastalarda uzak metastaz da¤›l›m›, klinik özellikleri ve uzak metastazlar›n tayini. Osmangazi T›p Dergisi 2007; 29(1): 13-28.
  • 26. Tanaka K, Kubota K, Kodama T, et al. Extrathoracic staging is not necessary for nonsmall-cell lung cancer with clinical stag T1-2 N0. Ann Thorac Surg. 1999; 68(3): 1039-42.
There are 26 citations in total.

Details

Other ID JA75HG39AD
Journal Section Case Report
Authors

Tuba Çınar This is me

Ceyda Anar This is me

İpek Ünsal This is me

Ufuk Yılmaz This is me

Erdal Ozantürk This is me

Hüseyin Halilçolar This is me

Publication Date May 1, 2010
Published in Issue Year 2010 Volume: 24 Issue: 1

Cite

APA Çınar, T., Anar, C., Ünsal, İ., Yılmaz, U., et al. (2010). KÜÇÜK HÜCRELİ DIŞI AKCİĞER KANSERİ BAŞLANGIÇ EVRELEMESİNDE KLİNİK DEĞERLENDİRME VE LABORATUVAR İLİŞKİSİ. İzmir Göğüs Hastanesi Dergisi, 24(1), 1-13.