Akciğer kanserinde prognostik faktörler

39 - 47, 19.10.2016

Nesimi Günal , Gültekin Gülbahar Erman Bağatur Öztürk Koray Dural

https://doi.org/10.18663/tjcl.38519

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

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