Küçük Hücreli Dışı Akciğer Kanseri Tanısıyla Opere Edilen Hastalarda t3n0 Tümörlerin Subgrubuna Göre Sağkalım Analizi Sonuçları

Öz

Amaç:  Akciğer kanserlerinin 8.TNM evrelemesine göre T3 tümörler heterojen bir grubu içermekte olup çap, aynı lobta satellit nodül ve invazyon (toraks duvarı, perikard, frenik sinir, parietal plevra) sebebiyle t3 kabul edilebilmektedir. Çalışmamızda aynı evredeki (evre IIB) T3 tümör subgrupları arasında sağkalım farkı araştırıldı.

Gereç ve Yöntemler: Çalışmamıza lokal etik onayını takiben Ocak2010-Aralık 2018 arasında Küçük Hücreli Dışı Akciğer Kanseri (KHDAK) tanısıyla opere edilen ve patolojik evrelemesi T3N0 olarak raporlanan hastalar dahil edildi. Hastalar yaş, cinsiyet, T3 alt grubu, histopatolojik tip, tümör çapı, parietal plevra invazyonuna göre analiz edildi.

Bulgular: Çalışmaya kriterleri taşıyan 83 hasta dahil edildi. Hastaların 72’ si (%86.8) erkek, 11’i (%13.2) kadındı. Median yaş 62 (36-81) ortalama tümör çapı 4.9 cm (SS:2.1) idi. Uygulanan operasyona göre 45 hastaya (%54.2) lobektomi, 9 hastaya (%12.1) bilobektomi, 14 hastaya (%16.9) pnömonektomi, 11hastaya (%13.2) akciğer rezeksiyonu + toraks duvar rezeksiyonu 3 hastaya  (%3.6) segmentektomi operasyonu yapıldı. T3 alt grubları şu şekilde idi; 38 hastada (%45.7) tümör çapı, 11 hastada (%13.2) çevre doku invazyonu, 7 hastada (%8.5) parietal plevra invazyonu (toraks duvarı invazyonu olmadan) ve 10 hastada (%12.1) aynı lobta satellit nodül ve 17 hastada (%20.5) çoklu- miks sebep mevcuttu. En kötü median sağkalım çevre invazyon alt grubunda 22 ay (7.1-37.0) iken, en iyi sağkalım çap subgrubunda idi.  Fark istatistiksel olarak anlamlı idi (p=0.001). Pnömonektomi grubunda sağkalım anlamlı olarak kötüydü (p=0.005).

Sonuç: KHDAK’ de aynı patolojik evredeki tümörlerde alt gruplar arasında anlamlı sağkalım farkı görülebilmektedir. Sonuçlar daha çok merkezli ve daha çok hasta sayısı içeren çalışmalarla desteklenirse kanser evrelemesinde ilave faktörler gündeme gelebilir. 

Anahtar Kelimeler

• Akciğer kanseri,Prognoz,pT3,8.TNM

Outcomes of Survival Analysis of Patients who Operated for NSCLC According to Subgroups of pT3 Tumors.

Öz

Aim: According to the 8th TNM lung cancer staging, T3 tumors are a heterogeneous group and the tumor accepted as T3 due to tumor diameter (5 to 7 cm), invasion the adjacent tissue (thoracic wall, pericardium, phrenic nerve, parietal pleura) and satellite malignant nodule in the same lobe. In our study, the survival difference between T3 tumor subgroups in the same stage (stage IIB) was investigated.

Material and methods: Following the approval of the local ethics committee, patients who were operated with a diagnosis of NSCLC between January 2010 and December 2018 and whose pathological staging was reported as pT3N0M0 were included. The data of patients were analyzed according to age, gender, pT3 subgroup, histopathological type, tumor diameter, visceral pleural invasion. 

Results: A total of 83 patients fulfilled the inclusion criteria were included in the study. 72 (%86.8) of the patients were male and 11 (13.2 %) were female. The median age was 62 (36-81) and mean tumor diameter was 4.9 cm (SD:2.1). The surgical resections were as follows;  lobectomy was performed in 45 patients (54.2%), bilobectomy in 9 patients (12.1 %), pneumonectomy in 14 patients (16.9 %), segmentectomy  in 3 patients (3.6%) and lung resection with chest wall resection in 11 patients (13.2 %). The pT3 subgroups were as follows, 38 (45.2%) diameter subgroups, 11 (13.7%) invasion subgroups, 7 (8.5%) parietal pleural invasion subgroups (without chest wall invasion), 10 (12.1%) satellite nodule subgroups and 17 (20.5%) multi-mix subgroups. The worst median survival was 22 months (7.1-37.0) in the invasion subgroup, while the best survival was in the diameter subgroup (median survival was 68.8 months, range 43.9-89.6 months). The difference was statistically significant (p = 0.001). Survival in the pneumonectomy group was significantly worse (p = 0.005).

Conclusion: In non-small cell lung cancer, tumors of the same pathological stage may show a significant survival difference between subgroups. If these results are supported by more centered and studies including more patients, there may be additional factors in lung cancer staging.

Anahtar Kelimeler

• Lung cancer,Prognosis,pT3,8th TNM

Kaynakça

1. Referans1. Blandin Knight S, Crosbie PA, Balata H, Chudziak J, Hussell T, Dive C. Progress and prospects of early detection in lung cancer. Open Biol. 2017 ;7. pii: 170070.
2. Referans2. Feng SH, Yang ST. The new 8th TNM staging system of lung cancer and its potential imaging interpretation pitfalls and limitations with CT image demonstrations. Diagn Interv Radiol. 2019; 25(4): 270–279.
3. Referans3. Woodard GA, Jones KD, Jablons DM. Lung Cancer Staging and Prognosis. Cancer Treat Res. 2016;170:47-75.
4. Referans4. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, 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.
5. Referans5. Kocaman G, Yüksel C, Yenigün BM, Sakallı MA, Karasoy D, Özkan M, Enön S, Kayı Cangır A. Curr Thorac Surg. 2016;1(1):12-15
6. Referans6. Asamura H, Chansky K, Crowley J et al . The International Association for the Study of Lung Cancer lung cancer staging project: proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung Cancer. J Thorac Oncol. 2015; 10:1675–1684.
7. Referans7. Blaauwgeers H, Damhuis R, Lissenberg-Witte BI, de Langen AJ, Senan S, Thunnissen E. A Population-Based Study of Outcomes in Surgically Resected T3N0 Non-Small Cell Lung Cancer in The Netherlands, Defined Using TNM-7 and TNM-8; Justification of Changes and an Argument to Incorporate Histology in the Staging Algorithm. J Thorac Oncol. 2019 ;14:459-467.
8. Referans8. Chiappetta M, Nachira D, Congedo MT, Meacci E, Porziella V, Margaritora S. Non-Small Cell Lung Cancer with Chest Wall Involvement: Integrated Treatment or Surgery Alone? Thorac Cardiovasc Surg. 2019; 67: 299-305.

9. Referans9. Gao SJ, Corso CD, Blasberg JD, Detterbeck FC, Boffa DJ, Decker RH, Kim AW. Role of Adjuvant Therapy for Node-Negative Lung Cancer Invading the Chest Wall. Clin Lung Cancer. 2017;18:169-177.
10. Referans10. Aytekin I, Sanli M, Isik AF, Tuncozgur B, Ulusan A, Bakir K, Kul S, Elbeyli L. Outcomes after lobectomy and pneumonectomy in lung cancer patients aged 70 years or older. Turk J Med Sci. 2017; 47:307–312.
11. Referans11. Ludwig C, Stoelben E, Olschewski M, Hasse J Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma. Ann Thorac Surg. 2005; 79:968–973
12. Referans12. Strand TE, Rostad H, Moller B, Norstein J (2006) Survival after resection for primary lung cancer: a population based study of 3211 resected patients. Thorax. 2006; 61:710–715.
13. Referans13. Cooke DT, Nguyen DV, Yang Y, Chen SL, Yu C, Calhoun RF. Survival comparison of adenosquamous, squamous cell, and adenocarcinoma of the lung after lobectomy. Ann Thorac Surg. 2010; 90: 943-8.
14. Referans14. Alpay L, Evman S, Doğruyol T, Kıral H, Laçin T, Vayvada M, et al. Survival in adenosquamous cancer of the lung: is it really so unfavorable?. Turk Gogus Kalp Dama. 2015;23:690-694.