Küçük hücreli akciğer kanseri tanısı alan hastalarımızın prospektif incelemesi: Tek merkezli çalışma

Öz

Amaç: Küçük hücreli akciğer kanseri en saldırgan akciğer kanseri türüdür. Küçük hücreli dışı akciğer kanserinin aksine son 30 yılda tedavide kaydadeğer bir ilerleme gösterilememiştir. Biz bu çalışmada SCLC hastalarının demografik, klinik, radyolojik özelliklerini, sigara ile ilişkisini, tedavi gecikmelerini, tedavi yanıtları, toksisiteleri, prognoza etki eden faktörleri ve yaşam sürelerini incelemeyi amaçladık. Yöntemler: Samsun Ondokuz Mayıs Üniversitesi Tıp Fakültesi Göğüs Hastaıklarında 4 yıllık sürede küçük hücreli akciğer kanseri tanısı alan hastalar prospektif kohort çalışmamıza dahil edildi. Hastaların demografik özellikleri, semptomları, performans durumları, laboratuvar, radyolojik, bronkskopik bulguları, evreleme tetkikleri, semptom başlangıcından bölümümüze müracat, müracattan tanıya kadar geçen süreler, kemoterapi yanıt ve toksisiteleri kaydedildi. Takipler bölümümüzde yapıldı. Hastanemiz dışında vefat eden hastaların ölüm tarihleri nüfus müdürlüğünden alındı. Takipten çıkan, eksik verisi olan veya onam vermeyen hastalar çalışmadan çıkarıldı. Bulgular: Çalışma grubu 88 hastadan oluşuyordu. Bu hastaların 82’si erkek, 6’sı kadındı. Ortalama yaş 61,16 idi. Başvuru anındaki esas semptomlar öksürük (%77), yorgunluk (%62), dispne (%60) olarak tespit edildi. Tanı anında hastaların %39’u sınırlı hastalık iken %61’i yaygın evrede idi. İlk semptomdan kliniğimize başvurana kadar geçen sure ortalama 30 gün, tanı konulmasına kadar geçen süre ise 10 gündü. 77 hastaya birinci basamak tedavi olarak cisplatin/carboplatin-etoposide, ikinci basamak tedavi olarak da irinotecan uygulandı. Genel ortalama yaşam süresi 355 (30,8) gün olup sınırlı hastalıkta 416 (47) gün, yaygın hastalıkta 29 (48) gün olarak bulundu (P=0,003). 6 aylık kümülatif survival %76 iken, 12 aylık kümulatif survival %44 idi. Tek değişkenli analalizlerde LDH seviyeleri artışı, performans skoru (PS) >1, yaygın hastalık ve kilo kaybı kötü prognostik faktörlerdi (P=0,042, 0,001, 0,003, 0,022). Çok değişkenli analizlerde ise serum LDH seviyeleri, performans skoru >1 ve yaygın hastalık bağımsız kötü prognostik faktörler olarak belirlendi. Sonuç: Kadın hasta oranımız halen dünya ortalaması altında. Hastaların kabulünden tanı konulana kadar geçen süre çoğu gelişmiş ülkeden daha kısa olmasına rağmen tedaviye yanıt oranları ve yaşam süreleri dünyada bildirilenlerin alt sınırındaydı. Evre, PS, LDH bağımsız prognostik faktor olarak kullanılabilir.

Anahtar Kelimeler

• Küçük hücreli akciğer kanseri
• Kemoterapi
• Prognoz
• Yaşam süresi

Prospective evaluation of patients with small cell lung cancer: A single center study

Abstract

Aim: Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. No major treatment advances have occurred for SCLC over the past 30 years, unlike non-small cell lung cancer (NSCLC). We aimed to prospectively examine demographic, clinical, radiological properties, its association with cigarette smoking, delays in diagnosis, treatment responses, toxicities, prognostic factors, and survivals. Methods: Patients diagnosed with small cell lung cancer during 4 years in Ondokuz Mayıs University, Department of Chest Diseases were included in our prospective cohort study. The demographic characteristics of the patients, symptoms, performance status, laboratory, radiologic, bronchoscopy findings, staging procedures, periods from the initiation of the symptoms to the admission of the patients to our department and definitive diagnosis, chemotherapy responses and toxicities were recorded. Follow-ups were performed in our clinic. Dates of deaths of patients who died outside our hospital were followed up from the records of census directorate. Patients that we lost to follow up, with missing data, or those who did not give consent for participation in the study were excluded. Results: The study group consisted of 88 patients (82 males, 6 females). The mean age was 61.16 years. The main symptoms on admission were cough (77%), fatigue (62%), dyspnea (60%). Among all, 39% of patients had limited disease whereas the remaining 61% were extensive. The median delay between the occurrence of first symptom and the patient’s presentation to our clinic was 30 days and the median delay before diagnosis was 10 days. Seventy-seven patients were given cisplatin/carboplatin-etoposide as the first line and irinotecan as second line chemotherapy. Overall median survival was 355 (30.8) days, 416 (47) days in limited stage and 296 (48) days in the extensive stage (P=0.003). Six-month cumulative survival was 76%, and 12-month cumulative survival was 44%. Univariate analysis showed that increased LDH levels, performance score >1, extensive stage and weight loss were poor prognostic factors (P=0.042, 0.001, 0.003, 0.022). In multivariate analysis, serum LDH levels, performance score >1 and extensive disease were independent poor prognostic factors. Conclusion: The ratio of our female patients is still much lower than the world average. Time from the admission of our patients to diagnosis was shorter than most of the developed countries. However, treatment response rates and survival periods were within lower limits of world reports. Stage, PS, LDH can be used as independent prognostic factors.

Keywords

• Small cell lung cancer
• chemotherapy
• Prognosis
• survival

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