CERRAHİ REZEKSİYON YAPILAN KÜÇÜK HÜCRELİ DIŞI AKCİĞER KANSERLİ KADIN HASTALARDA SAĞKALIMA ETKİ EDEN PROGNOSTİK FAKTÖRLER

Öz

Amaç Bu çalışmadaki amacımız, küçük hücreli dışı akciğer kanseri (KHDAK) nedeniyle rezeksiyon uygulanmış hastalarda prognostik faktörlerin cinsiyete bağlı olarak etkilerinin ve kadınlarda sağkalıma etki eden faktörlerin literatür eşliğinde değerlendirilmesidir. Gereç ve Yöntem Çalışmaya Ocak 2007-Aralık 2018 yılları arasında hastanemizde KHDAK nedeniyle akciğer rezeksiyonu uygulanmış hastalar dahil edilmiştir.1491 hasta çalışmaya dahil edilmiştir. Bulgular Hastaların ortalama yaşı 60,0±8,41 (aralık:26-84) yıl idi. 1324 (%88,8) erkek hasta, 167 (%11,2) kadın hasta çalışmada mevcuttu. 406 (%27,2) hastaya pnömonektomi, 1077 (%72,2) hastaya lobektomi ve 8 hastaya (%0,5) segmentektomi yapılmıştır. Ortalama 5 yıllık sağkalım süresi % 57.5 idi. Çalışmada kadın hastaların 5 yıllık sağkalım oranı %66,8 iken erkeklerde %56,4 idi (p=0.005). pN2 durumu değerlendirildiğinde 5 yıllık sağkalım oranı %34,3 iken, pN0 olan hastalarda sağkalım oranı %64,1 olarak saptanmıştır( p<0.001). Cox regresyon analizinde sağkalıma etki eden en önemli prognostik faktörler; cinsiyet, ileri yaş, geniş rezeksiyon yapmak, pN2 varlığı ve ileri evre olarak saptanmıştır. Subgrup analizinde kadın hastalardaki sağkalıma etki eden faktörler değerlendirildiğinde 65 yaş ve üzerinde olan hastalarda 5 yıllık sağkalım oranı %32.9 olarak saptanmıştır (p<0.001). Histopatoloji değerlendirildiğinde adenokarsinomlarda 5 yıllık sağkalım oranı %67,1 iken, skuamöz hücreli kanserlerde %70,7 olarak izlenmiştir. Sonuç Çalışmamız sonucunda kadın hastalarda görülen ana histopatolojik hücretipi adenokarsinomadır. Özellikle kadınlarda ileri yaş, büyük hücreli kanserler, ileri evre ve pN2 durumu sağkalımda kötü prognostik faktörlerdir.

Anahtar Kelimeler

• Akciğer Kanseri
• Sağkalım
• Prognostik Faktörler

PROGNOSTIC FACTORS FOR THE SURVIVAL OF SURGICALLY TREATED FEMALE PATIENTS FOR NON-SMALL CELL LUNG CANCER

Öz

Objective This study aims to evaluate the effects of prognostic factors depending on gender and the factors affecting survival in women patients who underwent resection for non-small cell lung cancer (NSCLC). Material and Methods Patients who underwent lung resection due to NSCLC in our hospital between January 2007 and December 2018 were included in the study. 1491 patients were included in the study. Results The mean age of the patients was 60.0±8.41 (range: 26-84) years. There were 1324 (88.8%) male patients and 167 (11.2%) female patients. Pneumonectomy was performed in 406 (27.2%) patients, lobectomy in 1077 (72.2%) patients, and segmentectomy in 8 patients (0.5%). The mean 5-year survival time was 57.5%. In the study, the 5-year survival rate of female patients was 66.8%, while it was 56.4% in males (p=0.005). When the pN2 status was evaluated, the 5-year survival rate was 34.3%, while the survival rate was 64.1% in patients with pN0 (p<0.001). The most important prognostic factors affecting survival in Cox regression analysis were gender, advanced age, wider resection, pN2, and advanced stage. When the factors affecting survival in female patients were evaluated in the subgroup analysis, the 5-year survival rate was 32.9% in patients aged 65 and over (p<0.001). When the histopathology was evaluated, the 5-year survival rate was 67.1% in adenocarcinomas, while 70.7% in squamous cell cancers. Conclusion As a result of our study, the main histopathological cell type seen in female patients is adenocarcinoma. Especially in women, advanced age, large cell cancers, advanced stage, and pN2 status are poor prognostic factors in survival.

Anahtar Kelimeler

• Lung Cancer
• Survival
• Prognostic Factors

Kaynakça

1. 1. Didkowska J, Wojciechowska U, Mańczuk M, Łobaszewski J. Lung cancer epidemiology: contemporary and future challenges worldwide. Ann Transl Med. 2016;4(8).
2. 2. Sezen CB, Kalafat CE, Doğru MV, Aker C, Erdogu V, Saydam O, et al. The Effect of Lymph Node Ratio on Survival in Non- Small-Cell Lung Cancer. Acta Chir Belg. 2021;(just-accepted): 1–18.
3. 3. Locher C, Debieuvre D, Coëtmeur D, Goupil F, Molinier O, Collon T, et al. Major changes in lung cancer over the last ten years in France: the KBP-CPHG studies. Lung Cancer. 2013;81(1):32–8.
4. 4. Lautamäki A, Gunn J, Sipilä J, Rautava P, Sihvo E, Kytö V. Women have a higher resection rate for lung cancer and improved survival after surgery. Interact Cardiovasc Thorac Surg. 2021;32(6):889–95.
5. 5. Fibla JJ, Molins L, Quero F, Izquierdo JM, Sánchez D, Hernández J, et al. Perioperative outcome of lung cancer surgery in women: results from a Spanish nationwide prospective cohort study. J Thorac Dis. 2019;11(4):1475.
6. 6. Belot A, Fowler H, Njagi EN, Luque-Fernandez M-A, Maringe C, Magadi W, et al. Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population- based study. Thorax. 2019;74(1):51–9.
7. 7. Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4(5):568–77.
8. 8. Radkiewicz C, Dickman PW, Johansson ALV, Wagenius G, Edgren G, Lambe M. Sex and survival in non-small cell lung cancer: A nationwide cohort study. PLoS One. 2019;14(6):e0219206.

9. 9. Nakamura H, Ando K, Shinmyo T, Morita K, Mochizuki A, Kurimoto N, et al. Female gender is an independent prognostic factor in non-small-cell lung cancer: a meta-analysis. Ann Thorac Cardiovasc Surg. 2011;17(5):469–80.
10. 10. Sakurai H, Asamura H, Goya T, Eguchi K, Nakanishi Y, Sawabata N, et al. Survival differences by gender for resected nonsmall cell lung cancer: A retrospective analysis of 12,509 cases in a Japanese lung cancer registry study. J Thorac Oncol. 2010;5(10):1594–601.
11. 11. Chatkin JM, Abreu CM, Fritscher CC, Wagner MB, Pinto JALF. Is there a gender difference in non-small cell lung cancer survival? Gend Med. 2004;1(1):41–7.
12. 12. Cerfolio RJ, Bryant AS, Scott E, Sharma M, Robert F, Spencer SA, et al. Women with pathologic stage I, II, and III nonsmall cell lung cancer have better survival than men. Chest. 2006;130(6):1796–802.
13. 13. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, 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.
14. 14. Yoshida Y, Murayama T, Sato Y, Suzuki Y, Saito H, Nomura Y. Gender differences in long-term survival after surgery for non-small cell lung Cancer. Thorac Cardiovasc Surg. 2016;64(06):507–14.
15. 15. van Rens MTM, van den Bosch JMM, de la Rivière AB, Elbers HRJ. Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA. Chest. 2000;117(2):374–9.
16. 16. Bonanno L, Attili I, Pavan A, Sepulcri M, Pasello G, Rea F, et al. Treatment strategies for locally advanced non-small cell lung cancer in elderly patients: translating scientific evidence into clinical practice. Crit Rev Oncol Hematol. 2021;103378.
17. 17. Kalathiya RJ, Saha SP. Pneumonectomy for non-small cell lung cancer: outcomes analysis. South Med J. 2012;105(7):350–4.
18. 18. Alexiou C, Beggs D, Rogers ML, Beggs L, Asopa S, Salama FD. Pneumonectomy for non-small cell lung cancer: predictors of operative mortality and survival. Eur J cardio-thoracic Surg. 2001;20(3):476–80.
19. 19. Aker C, Sezen CB, Ceritoglu A, Dogru MV, Aksoy Y, Kalafat CE, et al. Prognostic value of Glasgow Prognostic Score in patients with non-small cell lung cancers undergoing pN2 pneumonectomy. Curr Thorac Surg. 4(1).
20. 20. Dogru MV, Sezen CB, Aker C, Girgin O, Kilimci U, Erduhan S, et al. Evaluation of Factors Affecting Morbidity and Mortality in Pneumonectomy Patients. Acta Chir Belg. 2020;(just-accepted): 1–16.
21. 21. Caldarella A, Crocetti E, Comin CE, Janni A, Pegna AL, Paci E. Gender differences in non-small cell lung cancer: a population- based study. Eur J Surg Oncol. 2007;33(6):763–8.
22. 22. Hsu L-H, Chu N-M, Liu C-C, Tsai SYC, You D-L, Ko J-S, et al. Sex-associated differences in non-small cell lung cancer in the new era: is gender an independent prognostic factor? Lung Cancer. 2009;66(2):262–7.