Evre III küçük hücre dışı akciğer kanserli hastalarda sekizinci evreleme sisteminin prognostik etkileri

Year 2019, Volume: 11 Issue: 1, 47 - 53, 31.03.2019

Gül Kanyılmaz , Meryem Aktan Berrin Benli Yavuz Lütfi Saltuk Demir

https://doi.org/10.21601/ortadogutipdergisi.377255

Abstract

Amaç: Ocak 2017’ de akciğer kanserinin tümör, nod ve metastaz
(TNM) evreleme sınıflamasının 8. versiyonu yayımlanmıştır. Bu araştırmada evre
III küçük hücreli dışı akciğer kanseri (KHDAK) tanısıyla küratif
kemoradyoterapi (KRT) uygulanan hastalarda 7. ve 8. evreleme sisteminin
etkilerini karşılaştırmak ve gruplar arasındaki sağkalım farkını incelemek amaçlanmıştır.

Gereç
ve Yöntemler: Ocak 2010 ve Ocak 2017
tarihleri arasında KHDAK tanısıyla başvuran hastalardan klinik evre III kabul
edilerek küratif KRT uygulanan hasta verileri geriye dönük incelendi. 8.
versiyona göre olan T-evre ve TNM evre değişimleri kaydedildi. Eski ve yeni T-evre,
N-evre ve TNM evre kategorilerine göre sağkalım analizleri yapıldı.

Bulgular: Toplam 112 evre III KHDAK’li hastanın değerlendirildiği çalışmada
33 hastanın (%30) T-evresinde değişme saptanırken, 47 (%42) hastanın TNM evresinde değişiklik olmuştur. İleri yaş,
takip sırasında uzak organ metastazı gelişmesi, TNM evresi ve N-evresi sağkalımı
etkileyen bağımsız prognostik faktörler olarak bulunmuştur.

Sonuç: Sekizinci TNM evreleme sınıflamasına göre tümör
boyutu alt gruplara bölünerek T-evresinin yeniden sınıflandırılması lokal ileri
evre KHDAK’li hastalarda sağkalımı etkileyen bir parametre olarak
bulunmamıştır. Evre IIIa ve IIIc hastalar arasında anlamlı, evre IIIa ve IIIb
hastalar arasında anlamlılığa yakın bir sağkalım farkı bulunmasına rağmen evre
IIIb ve IIIc hastalar arasında anlamlı sağkalım farkı bulunamamıştır. N3
hastalığa sahip olmak tek başına sağ kalımı öngörecek bağımsız prognostik bir
faktör olarak saptanmıştır. 

Keywords

küçük hücreli dışı akciğer kanseri, prognostik faktörler, radyoterapi, evreleme

The prognostic effects of new eighth staging system for stage III non-small cell lung cancer

Abstract

Aim: The eighth tumour, node and metastasis (TNM) staging system for lung
cancer was published in January 2017. To compare the newly released 8^thversion
of TNM staging system with 7^th version of TNM staging system in
stage III non-small cell lung cancer patients (NSCLC) treated with curative
chemo-radiotherapy (CRT) and to evaluate the survival differences between the
groups were the aims of this study.

Material and Methods: Between January 2010 and January 2017, stage III NSCLC
patients who were treated with curative CRT were identified retrospectively.
Changes in T-stage and TNM-stage were according to 8^thstaging system
were recorded. Survival analysis were performed by using T-stage, N-stage and
TNM stage in each staging system, respectively.

Results: One hundred and twelve patients were included in this study. Of these 33
patients (30%) showed change in T-stage, whereas 47 patients (42%) had change
in TNM stage. Advanced age, distant organ metastasis during follow-up, TNM stage
and N-stage progression was found as independent prognostic factors affecting
survival.  

Conclusion: According to 8^th TNM staging system, subdivision of T-stage by tumour size did not affect the survival parameters
in locally advanced NSCLC patients. On the other hand, we found significant
survival difference between stage IIIa and IIIc. In regards of survival, although
there was a significant difference between patients with IIIa and IIIc, and
almost significance between patients with IIIa and IIIb, there was no significance
between stage IIIb and IIIc patients. Having N3 nodal disease was found to be
an independent prognostic factor of survival.

Keywords

non-small cell lung cancer, prognostic factors, radiotherapy, staging

References

• 1- https://gco.iarc.fr. Last accessed on 7 November 2017
• 2- Howlader N, Noone A.M, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2013, National Cancer Institute, Bethesda, MD, USA.
• 3- Auperin A, Le Pechoux C, Pignon JP, et al. On behalf of the metaanalysis of cisplatin/carboplatin based concomitant chemotherapy in non-small cell lung cancer (MAC3-LC) group: concomitant radiochemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a metaanalysis of individual data from 1764 patients. Ann Oncol 2006; 17: 473–83.
• 4- Berghmans T, Paesmans M, Sculier JP. Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 2011; 3: 127-38.
• 5- Detterbeck F, Tanoue L, Boffa DJ. The new lung cancer staging system. Chest 2009; 136: 260-71.
• 6- Golshaw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eight) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11: 39-51.
• 7- Chen K, Chen H, Yang F, Sui X, Li X, Wang J. Validation of the eighth edition of the TNM staging system for lung cancer in 2043 surgically treated patients with none small-cell lung cancer. Clin Lung Cancer 2017; 18: 457-66.
• 8- Yang L, Wang S, Zhou Y, et al. Evaluation of the 7th and 8th editions of the AJCC/UICC TNM staging systems for lung cancer in a large North American cohort. oncotarget 2017 24;8:66784-95.
• 9- Mitsudomi T. Molecular epidemiology of lung cancer and geographic variations with special reference to EGFR mutations. Transl Lung Cancer Res 2014; 3: 205-11.
• 10- Lv Y, Jin Y, Xu D, et al. Assessment of 64-slice spiral computed tomography with perfusion weighted imaging in the early diagnosis of ground-glass opacity lung cancer. J BUON 2016; 21: 954-57.
• 11- Choi HS, Jeong BK, Jeong H, et al. Application of the new 8th TNM staging system for non-small cell lung cancer: treated with curative concurrent chemoradiotherapy. Radiat Oncol 2017; 12: 122.
• 12- Okada M, Nishio W, Sakamoto T, et al. Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg 2005; 129: 87–93.
• 13- Ball D, Mitchell A, Giroux D, Rami-Porta R, Committee IS, Participating I. Effect of tumor size on prognosis in patients treated with radical radiotherapy or chemoradiotherapy for non-small cell lung cancer. An analysis of the staging project database of the International Association for the Study of Lung Cancer. J Thorac Oncol 2013; 8: 315–21.
• 14- Sculier JP, Chansky K, Crowley JJ, Van Meerbeeck J, Goldstraw P. International Staging Committee and Participating Institutions. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM classification of malignant tumors and the proposals for the 7th Edition. J Thorac Oncol 2008; 3: 457-66.