Akciğer kanserinde prognostik faktörler

Abstract

Amaç: Akciğer kanseri tüm dünyada kansere bağlı ölümlerde kadınlarda ve erkeklerde birinci sırada yer almaktadır. Cerrahi rezeksiyon küçük hücreli dışı akciğer kanserli (KHDAK) hastalarda en önemli tedavi şeklidir. Ancak rezeksiyon uygulanan erken evre hastalarda bile sağkalım istenilen seviyelere ulaşamamaktadır. Bu çalışmanın amacı cerrahi rezeksiyon uygulanan KHDAK hastalarında sağ kalım üzerinde etkili olabilecek faktörlerin araştırılmasıdır.

Gereç ve Yöntemler: 2003 ile 2006 yılları arasında KHDAK nedeniyle cerrahi rezeksiyon uygulanan 71 hastada çalışmaya dahil edildi. Hastalar, bir yıllık takip sonunda hayatta olanlar (Grup I, n = 37) ile bir yıllık takip sonunda exitus olanlar veya nüks gelişenler (Grup II, n = 34) olmak üzere iki gruba ayrıldı. Bu gruplar arasında hastaların, şikayet, laboratuar bulguları, tümör yerleşim yeri, çapı, lenf nodu durumu, evre ve tedavi şekli açısından farklılıklar araştırıldı.

Bulgular: En büyük tümör çapı grup I’de ortalama 40,2 mm, grup II’de ise 51,0 mm idi (P < 0,05). Otuzdört hastada N0, 17 hastada N1, 20 hastada da N2 vardı ve lenf nodu evresi grup I’de anlamlı olarak düşük saptandı (P < 0,05). Her iki grup evre yönünden evre I, II ve III olarak karşılaştırıldı ve evre grup I’de anlamlı olarak düşük saptandı (P < 0,05). Grup I ve grup II için ortalama CEA değerleri sırasıyla 3,26 ile 7,67 ng/mL’ydi (P < 0,05). Grup I ve grup II için ortalama CA 19-9 değerleri sırasıyla 13,35 ve 30,04 ng/mL’ydi (P < 0,05). Her iki grup arasında balgam çıkarma dışında anlamlı fark saptanmadı (P < 0,05).

Sonuçlar: Akciğer kanseri için tanımlanan prognostik faktörler farklılıklar göstermektedir. TNM evreleme sistemi KHDAK’li hastalarda prognozu en doğru yansıtan faktör olarak görünmekle birlikte aynı grup içinde serum CEA seviyesi benzeri faktörler de prognoza etki edebilmektedir. Ancak klinik heterojeniteden dolayı KHDAK’li tek bir hastanın prognozunu belirlemek zordur.

Anahtar kelimeler: Akciğer kanseri; prognoz; cerrahi rezeksiyon; evre; sağkalım

Keywords

• Akciğer kanseri, prognoz, cerrahi rezeksiyon, evre, sağkalım

The prognostic factors in lung cancer

Abstract

Aim: Lung cancer is the leading cause of cancer related deaths among women and men worldwide. Surgical resection is the treatment of choice in patients with non-small cell lung cancer (NSCLC). However, survival does not reach to desired levels even in patients with resection in an early stage. The aim of this study is to investigate the factors that may affect on survival in patients with NSCLC.

Material and Methods: Seventy-one lung cancer patients who treated with surgical resection between 2003 and 2006 were included in this study. The patients were divided into two groups as, group I the surviving patients (n = 37) and group II the patients died or with recurrent cancer (n = 34), after a follow-up period of one year. These two groups were compared for symptoms, laboratory findings, tumor localization, tumor size, lymph node status, stage and treatment modality.

Results: The mean longest dimension of the tumor was 40.2 mm in group I and 51.0 mm in group II (P < 0.05). N status was significiantly lower in group I (P < 0.05) as 34 patients have N0, 17 patients have N1 and 20 patients have N2 disease. Stage comparison was done according to stage I, II and III and stage was significantly lower in group I (P < 0.05). The mean level of CEA was 3.26 and 7.67 ng/mL in group I and II, respectively (P < 0.05). The mean level of CA 19-9 was 13.35 and 30.04 ng/mL in group I and II, respectively (P < 0.05). There was no significant difference for symptoms except for sputum complaint (P < 0.05).

Conclusion: Prognostic factors identified for lung cancer show variations. TNM staging system seems to be the most accurate factor reflecting  the prognosis in patients with NSCLC, while different factors such as CEA may influence on prognosis in the same patients. However, it is difficult to determine  the prognosis of an individual, because of the clinical heterogenity of NSCLC.

 Key words: Lung cancer; prognosis; surgical resection; stage; survival

References

1. Cangır AK, Öztürk S, Sak SD: Göğüs Cerrahisi. Akciğer kanserinde epidemiyoloji ve patoloji, İ. Ökten (editör), Türk Göğüs Cerrahisi Derneği, 1. baskı, 2. Cilt; 2003: 1061-1095.
2. Tanoue LT, Henschke CI, Shields TW, et al. General Thoracic Surgery. Carcinoma of the lung, T. W. Shields (editör), 6. baskı, 2. Cilt, Philedelphia, Lippincott Williams and Wilkins; 2005: 1425-587.
3. Işıtmangil T, Yılmazbayhan D, Kalaycı G. Göğüs Cerrahisi. Akciğer kanserinde tanı, evreleme, patoloji, cerrahi tedavi. M. Yüksel, G. Kalaycı (editörler), 1. baskı, İstanbul, Bilmedya Grup; 2001: 233-62.
4. Deslauriers J, Grégoire J. Clinical and surgical staging of non-small cell lung cancer. Chest 2000-b; 117: 96-103.
5. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997-a; 111: 1718-23.
6. Mountain CF: Lung cancer. International staging system for lung cancer, Pass HI, Mitchell JB, Johnson DH, Turrisi AT, Minna JD (editörler), 2. baskı, Philedelphia, Lippincott Williams and Wilkins; 2000: 591-601.
7. Vincent RG, Pickren JW, Lane WW, et al. The changing histopathology of lung cancer: a review of 1682 cases. Cancer 1977; 39: 1647-55.
8. Barsky SH, Huang SJ, Bhuta S. The extracellular matrix of pulmonary scar carcinomas is suggestive of a desmoplastic origin. AM J Pathol 1986; 124: 412-9.

9. Madri JA, Carter D. Scar cancers of the lung: origin and significance. Hum Pathol 1984; 15: 625-31.
10. Suzuki K, Yokose T, Yoshida J, et al. Prognostic significance of central fibrozis in peripheral adenocarcinoma of the lung. Ann Thorac Surg 1981; 69: 893-7.
11. Sagawa M, Saito Y, Takahashi S, et al. Clinical and prognostic assessment of patient with resected small peripheral lung cancer lesions. Cancer 1990; 66: 2653-7.
12. Kodama K, Doi O, Higashiyama M, et al. Intentional limited resection for selected patients with T1N0M0 non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 114; 347-53.
13. Kara M, Dikmen E, Kılıç D, et al. Prognostic implications of microscopic proximal bronchial extention in non-small cell lung cancer. Ann Thorac Surg 2002; 74: 348-54.
14. Jazieh AR, Hussain M, Howington JA, et al. Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer. Ann Thorac Surg 2002; 70: 1168-71.
15. Brundage MD, Davies D, Mackillop WJ. Prognostic factors in non-small cell lung cancer: a decade of progress. Chest 2002; 122: 1037-57.
16. Bulzebruck H, Krysa S, Bauer E, Probst G, Drings P, Vogt-Moykopf I. Validation of the TNM classification for lung cancer. Fast results of a prospective study of 1086 patients with surgical treatment. Eur J Cardiovasc Sur 1991; 5: 356-62.
17. Fernando HC, Goldstraw P. The accuracy of clinical evaluative intrathoracic staging in lung cancer as assessed by postsurgical pathologic staging. Cancer 1990; 65: 2503-6.
18. Okada M, Nishio W, Sakamoto T, Harada H, Tsubota N. Long-term survival and prognostic factors with complete resection of non-small cell lung carcinoma. J Thorac Cardiovasc Surg 2003; 126: 558-62.
19. Tomita M, Matsuzaki Y, Shimizu T, Hara M, Ayabe T, Onitsuka T. Preoperative prognostic factors for pN2 non-small cell lung cancer. Ann Thorac Surg 2006; 12: 15-20.
20. Ishida T, Yokoyama H, Kaneko S, Sugio K, Sugimachi K. Long-term results of operation for non-small cell lung cancer in the elderly. Ann Thorac Surg 1990; 50: 919-22.
21. Sawada S, Komori E, Nogami N, et al. Advanced age is not correlated with either short-term or long-term postoperative results in lung cancer patients in good clinical condition. Chest 2005; 128: 1557-63.
22. Vansteenkiste JF, De Leyn PR, Deneffe GJ, et al. Survival and prognostic factors in resected N2 non-small cell lung cancer: a study of 140 cases. Ann Thorac Surg 1997; 63: 1441-50.
23. 0Thomas P, Doddoli C, Thirion X, et al. Stage I non-small cell lung cancer: a pragmatic approach to prognosis after complete resection. Ann Thorac Surg 2002; 73: 1065-70.
24. Kato I, Tominaga S, Ikari A. Lung cancer prognostic factors from the Aichi Cancer Registry. Jpn J Clin Oncol 1990; 20: 238-45.
25. Okamoto T, Maruyama R, Suemitsu R, et al. Prognostic value of the histological subtype in completely resected non-small cell lung cancer. Interact cardiovasc Thorac Surg 2006; 5: 362-6.
26. Sawabata N, Ohta M, Takeda S, et al. Serum carcinoembryonic antigen level in surgically resected clinical stage I patients with non-small cell lung cancer. Ann Thorac Surg 2002; 74: 174-9.
27. Sakao Y, Nakazono T, Sakuragi T, Natsuaki M , Itoh T. Predictive factors for survival in surgically resected clinical IA peripheral adenocarcinoma of the lung. Ann Thorac Surg 2004; 77: 1157-61.
28. Okada M, Nishio W, Sakamoto T, Uchino K, Tsubota N. Discrepancy of computed tomographic image between lung and mediastinal windows as a prognostic implication in small lung adenocarcinoma. Ann Thorac Surg 2003; 76: 1828-32.
29. Lee JH, Machtay M, Kaiser LR, et al. Non-small cell lung cancer: prognostic factors in patients treated with surgery and postoperative radiation therapy. Radiology 1999; 213: 845-52.
30. Yanagi S, Sugiura H, Morikawa T, et al. Tumor size does not have prognostic significance in stage Ia non-small cell lung cancer. Anticancer Res 2000; 18: 1155-8.
31. Martini N, Ginsberg RJ: Thoracic Surgery. Sugical management. FG Pearson, J Deslauriers, RJ Ginsberg (editörler). New York, Churchill Livingston; 1995: 690-705.
32. Rami-Porta R, Mateu-Nawarro M, Freixinet J, et al. Type of resection and prognosis in lung cancer. Experience of a multicentre study. Eur J Cardiothorac Surg 2005; 28: 622-8.
33. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978; 76: 832-9.
34. Mountain CF: Lung Cancer. Biologic, physiologic, and technical determinants in surgical theraphy in lung cancer, MJ Straus (editör). 2. baskı, New York, Grune and Stratton; 1983: 245-60.
35. Thomas PA, Piantadosi S, Mountain CF, The Lung Cancer Study Group. Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer? J Thorac Cardiovasc Surg 1988; 95: 883-7.
36. Goldstraw P, Mannam GC, Kaplan DK, Michail P. Surgical management of non-small cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). J Thorac Cardiovasc Surg 1994; 107: 19-28.
37. Sakao Y, Sakuragi T, NAtsuaki M, Itoh T. Clinicopathological analysis of prognostic factors in clinical IA peripheral adenocarcinoma of the lung. Ann Thorac Surg 2003; 75: 1113-7.
38. Martini N, Flehinger BJ. The role of surgery in N2 lung cancer. Surg Clin North Am 1987; 67: 1037-49.
39. Maggi G, Casadio C, Cianci R, et al. Results of surgical resection of stage IIIa (N2) non-small cell lung cancer, according to the site of the mediastinal metastases. Int Surg 1993; 78: 2013-7.
40. Sagawa M, Sakurada A, Fujimura S, et al. Five-year survivors with resected pN2 non-small cell lung cancer. Cancer 1999; 85: 864-8.
41. Osaki T, Sugio KS, Hanagiri T, et al. Survival and prognostic factors of surgically resected T4 non-small cell lung cancer. Ann Thorac Surg 2003; 75: 1745-51.
42. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg 1975; 70: 606-12.
43. Ginsberg RJ, Rubenstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac Surg 1995; 60: 615-23.
44. Song SW, Lee HS, Kim MS, et al. Preoperative serum fibrinogen level predicts postoperative pulmonary complications after lung cancer resection. Ann Thorac Surg 2006; 81: 1974-81.
45. Riquet M, Foucault C, Berna P, Assouad J, Dujon A, Danel C. Prognostic value of histology in resected lung cancer with emphasis on the relevance of the adenocarcinoma subtyping. Ann Thorac Surg 2006; 81: 1988-95.
46. Nesbitt JC, Putnam JB, Walsh GL, Roth JA, Mountain CF. Survival in early-stage non-small cell lung cancer. Ann Thorac Surg 1995; 60: 466-72.
47. Gail MH, Eagan RT, Feld R, et al. Prognostic factors in patients with resected stage I non-small cell lung cancer. A report from the Lung Cancer Study Group. Cancer 1984; 54: 1802-13.
48. Vincent RG, Chu TM, Fergen TB, Ostrander M. Carcinoembryonic antigen in 228 patients with carcinoma of the lung. Cancer 1975; 36: 2069-76.
49. Concannon JP, Dalbow MH, Hodgson SE, et al. Prognostic value of preoperative carcinoembryonic antigen (CEA) plasma levels in patients with bronchogenic carcinoma. Cancer 1978; 42; 1477-83.
50. Tomita M, Matsuzaki Y, Edagawa M, Shimizu T, Hara M, Onitsuka T. Prognostic significance of preoperative serum carcinoembryonic antigen level in lung adenocarcinoma but not in squamous cell carcinoma. Ann Thorac Cardiovasc Surg 2004; 10: 76-80.
51. Vincent RG, Chu TM, Lane WW. The value of carcinoembryonic antigen in patients with carcinoma of the lung. Cancer 1979: 44; 685-91.
52. Okada M, Nishio W, Sakamoto T, et al. Prognostic significance of perioperative serum carcinoembryonic antigen in non-smal cell lung cancer: analysis of 1,000 consecutive resections for clinical stage I disease. Ann Thorac Surg 2004; 78: 216-21.
53. D’Amico TA, Brooks KR, Joshi MM, et al. Serum protein expression predicts recurrence in patients with early-stage lung cancer after resection. Ann Thorac Surg 2006; 81: 1982-7.
54. Kim JE, Lee KT, Lee JK, Paik SW, Rhee JC, Choi KW. Clinical usefulness of carbohydrate antigen 19-9 as a screening test for pancreatic cancer in an asymptomatic population. J Gastroenterol and Hepatol 2004; 19: 182-6.
55. Niklinski J, Furman M, Laudansky J, Kozlowski M. Prognostic value of pretreatment CEA, SCC-Ag and CA 19-9 levels in sera of patients with non-small cell lung cancer. Eur J Cancer Prev 1992; 1: 401-6.