Akciğer kanserinde prognostik faktörler

Öz

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

Anahtar Kelimeler

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

The prognostic factors in lung cancer

Öz

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

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