Kenan Can Ceylan, Ali Hızır Arpat, Şeyda Örs Kaya

Comparison of Clinical and Pathological Staging in Non-Small Cell Lung Cancer

Amaç: Operasyon uygulanan küçük hücreli dışı akciğer kanserli (KHDAK) olgularda klinik ve patolojik evrelerin karşılaştırılarak klinik evreleme yöntemlerinin KHDAK evrelemesindeki etkinliğinin araştırılması amaçlandı. Hastalar ve Yöntem: Ocak 2005 - Ocak 2009 tarihleri arasında opere edilen 365'i erkek 37'si kadın toplam 402 KHDAK tanılı olgu değerlendirildi. Neoadjuvan tedavi uygulanan, mediastinoskopide N2 veya N3 saptanan, lenf nodu örneklemesi veya sistematik lenf nodu diseksiyonu yapılmayanlar ile uzak metastazı olan olgular çalışma dışı bırakıldı. Non-invaziv evreleme toraks bilgisayarlı tomografi (BT) ve 103 olguya pozitron emisyon tomografisi (PET-BT) ile yapıldı. Mediastinoskopi 80 hastaya uygulandı. Operasyonda alınan tüm materyaller histopatolojik olarak incelenerek patolojik evreleme yapıldı. Bulgular: Yaş ortalaması 61.36±9.71 idi. Erkeklerde en sık (%54.2) skuamöz hücreli karsinom, kadınlarda ise adenokarsinoma (%73) saptandı. BT'nin T faktöründe doğruluk oranı %70 olarak bulundu. En iyi uyum %79.2 ile T2'nin değerlendirilmesinde, en düşük uyum %31.8 ile T4'de bulundu. N faktöründe doğruluk oranı BT'nin %74, PET-BT'nin ise %89 idi. T,N faktörleri birlikte değerlendirildiğinde; klinik ve patolojik uyum en iyi evre Ib olgularında %61.3 iken tüm olguların klinik ve patolojik uyumu %54.4 bulundu. Sonuç: Noninvaziv ve invaziv yöntemler kullanılsa bile olguların ancak yarısı doğru evrelendirilmektedir. KHDAK olgular için en iyi evreleme operasyon bulguları ve mediastinal lenf bezi diseksiyonu ile olabilmektedir.

Anahtar Kelimeler:

Küçük Hücreli Dışı Akciğer Kanseri, klinik evreleme, patolojik evreleme

Küçük Hücreli Dışı Akciğer Kanserinde Klinik ve Patolojik Evrelemenin Karşılaştırılması

Purpose: The aim of this study is to compare the clinical and the pathological staging results and to evaluate the value of clinical staging methods. Patients and Methods: Between January 2005 and January 2009, a total of 402 patients (365 male, 37 female) were operated with non-small cell lung cancer (NSCLC), were evaluated. The patients who received neoadjuvant therapy, having N2 or N3 disease proven by mediastinoscopy or having distant metastatic disease, patients without lymph node dissection or sampling were excluded from the study. All patients underwent CT, and 103 patients underwent PET-CT. Mediastinoscopy was performed 80 patients. All the specimens were examined histopathologically and staging was done according to these results. Results: The mean age was 61.36 ± 9.71. The most common type was squamous cell carcinoma in males (%54.2) and adenocarcinoma in females ( %73). The accuracy of thorax CT was %70 in the staging of T factor. The highest complaince between clinically and pathological results was seen in the T2 factor (% 79.2) and the lowest was in T4 factor (% 31.8). The accuracy of thorax CT was 74%, accuracy of PET-CT was 89% in N factor. When T and N factors are evaluated together, the highest complaince between clinically and pathological results was in stage Ib (61.3%) where it was 54.4% in all the study population. Conclusion: By the usage of non-invasive and invasive methods, only 50% of the non-small cell lung cancer patients are staged correctly. For NSCLC the best staging is achieved by operative findings and mediastinal lymph node dissection.

Keywords:

Non Small Cell Lung Cancer, clinical staging, pathological staging,

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Tablo 1. Operasyonda uygulanan rezeksiyon tipleri Pnömonektomi Lobektomi Wedge Eksploratris Segmentektomi rezeksiyon torakotomi n(%) n (%) n(%) n(%) n (%) Sağ 36(8.9) 183 (45.5) 6(1.5) 6(1.5) 2(0.5) Sol 41(10.2) 117(29.1) 5(1.2) 6(1.5) - Toplam 77 (19.1) 300(74.6) 11(2.7) 12(2.9) 2(0.5)