Küçük Hücreli Dışı Akciğer Kanserinde Cerrahi Yapılan Hastalarda N2 Lenf Nodu Pozitifliğinin Sağkalıma Etkisi

Öz

Amaç: Çalışmamızda, küçük hücreli dışı akciğer kanseri tanılı ve akciğer rezeksiyonu yapılan hastalar arasından ipsilateral mediastinal metastatik lenf nodu (N2) olanlar belirlenerek, N2 lenf noduna klinik yaklaşıma göre oluşturulan sürpriz N2 ile olası rezektabl N2 gruplarının sağkalıma etkisini araştırmak amaçlanmıştır. Materyal ve Metod: 2011 ile 2017 yılları arasında küçük hücreli dışı akciğer kanseri (KHDAK) tanısıyla anatomik akciğer rezeksiyonu ve mediastinal lenf nodu diseksiyonu uygulanan 953 hastanın retrospektif tarandığı tek merkezli bir kohort çalışmasıdır. Bulgular: Ocak 2011 ile Aralık 2017 tarihleri arasında, hastanemizde KHDAK nedeniyle akciğer rezeksiyonu uygulanan 953 hasta retrospektif olarak tarandı. Hastalar cN2 olmayan fakat postoperatif pN2 gösterilen olgular (grup1), cN2 olup öncelikle cerrahiye alınanlar (grup 2), cN2 olup neoadjuvan KT veya KRT tedavi sonrasında pN2’leri stabil seyreden veya kısmi regresyon gözlenip cerrahi uygulananlar (grup 3) olarak üçe ayrıldı. Postoperatif pN2 olan 71 (%7,45) hasta çalışmaya dahil edildi. Çalışmamızdaki 71 hastanın 41(57.74%)’inde cN2 saptanmayıp postoperatif pN2 olarak değerlendirildi (grup 1). Yirmi (28.16%) hasta tek cN2 olan seçilmiş kondisyonu iyi hasta olarak değerlendirilip cerrahi uygulandı (grup 2). 10 (14.08%) hasta ise neoadjuvant tedavi gören sonrasında da tek N2si olan seçilmiş hastalardı ve anatomik rezeksiyon uygulandı (Grup 3). Gruplar arasında sağ kalım açısından anlamlı istatistiksel bir faklılık saptanmadı (p=0.882). Sonuç: Mediasten lenf nodu metastazı olan KHDAK hastalarının tedavisinde cerrahi tedavinin yeri konusunda görüş birliği bulunmamaktadır. N2 alt gruplarının incelenmesi için daha geniş hasta gruplarıyla çalışmaların gerekliliği ortaya konmuştur.

Anahtar Kelimeler

• Küçük hücreli dışı akciğer kanseri
• N2
• mediastinal lenf nodu
• sürpriz N2
• skip N2.

The Impact of N2 Lymph Node Positivity on Survival Rates Among Patients Undergoing Surgery for Non-Small Cell Lung Cancer

Öz

ABSTRACT Objective: In this study, our aim was to examine the impact of unexpected N2 and potentially resectable N2 groups, which were categorized based on the clinical approach to N2 lymph node involvement, on the survival outcomes of patients who underwent lung resection for non-small cell lung cancer. Specifically, we focused on identifying patients with ipsilateral mediastinal metastatic lymph nodes (N2) and assessing their survival rates. Material and Method: A retrospective cohort study was conducted at a single center, comprising a total of 953 patients who underwent anatomical lung resection and mediastinal lymph node dissection for non-small cell lung cancer (NSCLC) between the years 2011 and 2017. Results: Between January 2011 and December 2017, a retrospective review was conducted on 953 patients who underwent lung resection for non-small cell lung cancer (NSCLC) at our hospital. Patients were categorized into three groups: patients without initial clinical N2 involvement but with postoperative pathological N2 involvement (group 1), patients with initial clinical N2 involvement who underwent immediate surgery (group 2), and patients with initial clinical N2 involvement who demonstrated stable pathological N2 involvement or partial regression after receiving neoadjuvant chemotherapy or chemoradiotherapy and subsequently underwent surgery (group 3). A total of 71 patients (7.45% of the cohort) with postoperative pN2 were included in this study. Among these 71 patients, 41 (57.74%) did not have initial cN2 involvement and were categorized as postoperative pN2 (group 1). Twenty patients (28.16%) with a single cN2 were considered as carefully selected patients and underwent surgery (group 2). Ten patients (14.08%) were selected patients who received neoadjuvant treatment and subsequently had a single N2 involvement, and they underwent anatomical resection (group 3). Statistical analysis revealed no significant differences in survival between the three groups (p=0.882). Conclusion: No consensus currently exists regarding the role of surgery in the management of patients with NSCLC and mediastinal lymph node metastases. Existing evidence suggests that studies encompassing larger patient cohorts are necessary to comprehensively investigate the subgroups of patients with N2 disease.

Anahtar Kelimeler

• non-small cell lung cancer
• N2
• mediastinal lymph node
• surprise N2
• skip N2

Kaynakça

1. 1.Köksel O. Akciğer kanseri epidemiyolojisi ve karsinogenez. In Göğüs Cerrahisi. 2. Baskı. (Eds Ökten İ, Kavukçu HŞ) 1029-44. İstanbul, İstanbul Tıp Kitabevi, 2013.
2. 2.Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-E386. https://doi.org/10.1002/ijc.29210
3. 3.Johnson DH, Rusch VW, Turrisi AT. Scalpels, beams, drugs, and dreams: challenges of stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst. 2007;99(6):415-8. https://doi.org/10.1093/jnci/djk107
4. 4.Şencan İ, İnce G N, Gültekin M, et al. Türkiye Kanser İstatistikleri. Türkiye Kamu Halk Sağlığı Kurumu, Ankara (2016).
5. 5.Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39-51. https://doi.org/10.1016/j.jtho.2015.09.009
6. 6.Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-8. https://doi.org/10.7326/M13-2771
7. 7.Sugarbaker, David J. 2011. Erişkin Göğüs Cerrahisi. [çev.] Mustafa Yüksel. İstanbul: Nobel Tıp Kitabevleri, 2011. s. 508.
8. 8.Gürses A, Turna A, Bedirhan MA, et al. The value of mediastinoscopy in preoperative evaluation of mediastinal involvement in non-small-cell lung cancer patients with clinical NO disease. Thorac Cardiovasc Surg. 2002;50(3):174-7. https://doi.org/10.1055/s-2002-32416

9. 9.Youlden DR, Cramb SM, Baade PD. The International Epidemiology of Lung Cancer: geographical distribution and secular trends. J Thorac Oncol. 2008;3(8):819-31. https://doi.org/10.1097/JTO.0b013e31818020eb
10. 10.Eberhardt WE, Pöttgen C, Gauler TC, et al. Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA(N2) and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy (ESPATUE). J Clin Oncol. 2015;33(35):4194-201. https://doi.org/10.1200/JCO.2015.62.6812
11. 11.McGuire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr. 2016;7(2):418-419. Published 2016 Mar 15. https://doi.org/10.3945/an.116.012211
12. 12.Al-Sarraf N, Aziz R, Gately K, et al. Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography. Eur J Cardiothorac Surg. 2008;33(1):104-9. https://doi.org/10.1016/j.ejcts.2007.09.026
13. 13.Robinson LA, Ruckdeschel JC, Wagner H Jr, Stevens CW; American College of Chest Physicians. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):243S-265S. https://doi.org/10.1378/chest.07-1379
14. 14.Ramnath N, Dilling TJ, Harris LJ, et al. Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e314S-e340S. https://doi.org/10.1378/chest.12-2360
15. 15.Detterbeck F. What to do with "Surprise" N2?: intraoperative management of patients with non-small cell lung cancer. J Thorac Oncol. 2008;3(3):289-302. https://doi.org/10.1097/JTO.0b013e3181630ebd
16. 16.Andre F, Grunenwald D, Pignon JP, et al. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol. 2000;18(16):2981-9. https://doi.org/10.1200/JCO.2000.18.16.2981
17. 17.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. Leuven Lung Cancer Group. Ann Thorac Surg. 1997;63(5):1441-50. https://doi.org/10.1016/s0003-4975(97)00314-7
18. 18.Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374(9687):379-386. https://doi.org/10.1016/S0140-6736(09)60737-6