Ayten Cangır KAYI, Sema BİRCAN, Ayşe SERTÇELİK, Sibel PERÇİNEL

The significance of neuroendocrine differentiation in patients with resected non-small cell lung carcinoma

Amaç: Nöroendokrin diferansiyasyon (NED) en sık adenokarsinomlar(AD’ler) ve büyük hücreli karsinomlar (BHK’ler) olmak üzere küçükhücreli dısı akciğer karsinomlarının (KHDAK’lerin) %10-30’unda im- münhistokimyasal veya elektron mikroskopik yöntemler ile saptanabilir.Bu tümörler kollektif olarak “nöroendokrin diferansiyasyon gösterenküçük hücreli dısı akciğer karsinomları (KHDAK-NED)” olarak isim- lendirilirler. Ancak bu özelliğin klinik olarak önemi KHDAK-NED’de tamolarak aydınlatılamamıstır. Bu çalısmada evre I-IV KHDAK’li hastalardanöroendokrin belirleyiciler için immünhistokimyasal yöntem kullanılarakNED’nin sıklığı ve klinik öneminin değerlendirilmesi amaçlanmıstır. Gereç ve Yöntem: Cerrahi olarak rezeke edilmis evre I-IV KHDAK’li71 hastada immünhistokimyasal olarak nöron spesifk enolaz (NSE), kro- mogranin A (Kr A) ve nöroflament (NF) kullanılmasıyla NED ve prog- noz arasındaki iliski arastırılmıstır. Nöroendokrin belirleyicilerin immün- boyanma sonuçları sağkalım verileri ile karsılastırılmıstır. Bulgular: NSE ekspresyonu en sık BHK’lerde (%66.7) saptanırken, Kr Aekspresyonu ise en sık AD’lerde (%25.8) gözlenmistir ancak NF ile hiç- bir KHDAK olgusunda immünreaktiviteye rastlanmamıstır. Multivary- ans analiz KHDAK olgularında; lobektomiye karsılık pnömomektomiuygulanmasının olumsuz, NSE ekspresyonunun ise olumlu prognostikfaktör olduğunu ortaya koymustur. Sonuç: Rezeke KHDAK hastalarında NED’nin prognostik bir önemiolabilir ancak daha genis olgu serileri üzerinde spesifk antikorlarlaçalısılarak, bu hasta popülasyonunda NED klinik açıdan daha ayrıntılıarastırılmayı gerektirmektedir.

Rezeke küçük hücreli dısı akciğer karsinomlu hastalarda nöroendokrin diferansiyasyonun önemi

Purpose: Neuroendocrine differentiation (NED) can be detected in 10- 30% of non-small cell lung carcinomas (NSCLCs), with the highest fre- quency in adenocarcinomas (ACs) and large cell carcinomas (LCCs), byimmunohistochemical or electron microscopic techniques. These tumorsare collectively referred to as non-small cell lung carcinomas with neu- roendocrine differentiation (NSCLC-NED). However, the clinical signif- cance of this feature is not fully elucidated in NSCLC-NED. The purposeof this study was to evaluate the prevalence and the clinical signifcance ofNED in patients with stage I-IV NSCLC by using immunohistochemistryfor neuroendocrine markers. Materials and Methods: The relationship between NED and prognosiswas investigated by immunohistochemistry using neuron specifc enolase(NSE), chromogranin A (Chr A), and neuroflament (NF) in 71 patientswith surgically resected stage I-IV NSCLC. The immunostaining resultsof NE markers were compared with survival data. Results: While NSE expression was detected most often in LCCs (66.7%),that of Chr A was seen mostly in ACs (25.8%) but none of the NSCLCcases showed immunoreactivity with NF. Multivariate analysis showedthat pneumonectomy versus lobectomy carried a poorer prognosis whileNSE expression predicted a better prognosis in NSCLC cases. Conclusion: NED may be of prognostic signifcance in patients with re- sected NSCLC but the clinical signifcance of NED in this subpopulationneeds further analysis with specifc antibodies in larger series.

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