Tuğba GÜNLER, Pınar KARABAĞLI, Zeliha Esin ÇELİK, Ceyhan UĞURLUOĞLU

Küçük hücre dışı akciğer karsinomlarinda biyolojik davranışın belirlenmesinde p53 ve ki-67 ekspresyonunun değeri

Amaç: Akciğer karsinomlarında yapılan son çalışmalar, tümörü erken evrede tespit etme, nüks ve mortalite riskini belirleme ile hedef tedavide etkili olan klinikopatolojik faktörleri saptamak için yürütülmektedir. Bu çalışmamızda rezeke edilen küçük hücre dışı akciğer karsinom(KHDAK)olgularını 2015 Dünya Sağlık Örgütü (DSÖ) sınıflamasına göre yeniden değerlendirerek, p53 ve Ki-67'nin immünohistokimyasal ekspresyonunun klinikopatolojik parametreler ile ilişkisini ve prognostik önemini belirlemeyi amaçladık.Gereç ve Yöntem: Rezeksiyon materyallerinde KHDAK tanısı alan Evre I - III arasındaki 125 olguda retrospektif olarak klinikopatolojik özellikler (cinsiyet, yaş, sigara kullanımı, tümör boyutu, plevra invazyonu, lenf nodu tutulumu, evre, sağkalım) ile p53 ve Ki-67 immunhistokimyasal ekspresyonu değerlendirildi.Bulgular: p53 ekspresyonu 125 olgunun 61’inde>%10’du. Ki-67 ekspresyonunun ortalama değeri %32,9’du. Hem p53 hem de Ki-67 ekspresyonunun tümörün histolojik tipler ile ilişkisi incelendiğinde anlamlı sonuçlar bulundu (p=0,036 ve p=0,000). Ki-67’den farklı olarak p53 ekspresyonu adenokarsinom (ADK) alt tiplerinde derece yükseldikçe anlamlı yüksek bulundu (p=0,036). Yüksek Ki-67 ekspresyonu tümör boyutu ve evre artışı ile ilişkiliydi (p=0,008 ve p=0,020). Tek değişkenli ve çok değişkenli analizlerde prognozu etkileyen faktörler yaş ve tümörün evresi idi (p=0,021 ve p=0,041). Klinikopatolojik bulgular sağkalıma tek başına etkili değildi. Wald testi p53 ve Ki-67 ekspresyonu, sigara ve cinsiyet ile genel sağkalım arasında anlamlı bir ilişki olmadığını ortaya koymuştur.Sonuç: KHDAK’larında Ki-67 ekspresyonu büyük tümör boyutu ve ileri evre ile güçlü bir ilişkiyi göstermektedir. p53 mutasyonu skuamöz hücreli karsinomlarda ve özellikle ADK solid varyantta daha sık görülmektedir. Bununla birlikte, p53 ve Ki-67 proteinlerinin prognostik öneminin daha büyük hasta gruplarında ve uzun süreli takiplerle araştırılmasının daha anlamlı sonuçlar sunabileceği ön görülmektedir.

The value of p53 and ki-67 expression in determining biological behavior in non-small cell lung carcinomas

Objective: Recent studies of lung carcinomas have been conducted to detect tumors in early-stage disease, to determine the risk of recurrence and mortality, and to determine the clinicopathological factors that are effective in targeted treatment. The aim of this study was to determine the prognostic value and association of immunohistochemical expression of p53 and Ki-67 with clinicopathological parameters in non-small cell lung carcinoma (NSCLC) and their variants. Material and Methods: Clinicopathological features and p53 and Ki-67 expression were evaluated retrospectively in 125 patients diagnosed with NSCLC based on lung resection materials. The resected materials were assessed according to the 2015 World Health Organization (WHO) classification. Results: p53 expression was > 10% in 61 of 125 cases. The average value of Ki-67 expression was 32.9%. Both p53 and Ki-67 expression were significantly associated with the histological tumor type (p=0.036 and p=0.000, respectively). p53 expression was significantly elevated in adenocarcinoma (ADC) subtypes when the stage increased (p=0.036). High Ki-67 expression was associated with tumor size and stage increase (p=0.008 and p=0.020, respectively). Factors affecting the prognosis in univariate-multivariate analyses were age and tumor stage (p=0.021 and p=0.041, respectively). Conclusion: Ki-67 expression in NSCLC shows a strong association with large tumor size and advanced stage.p53 mutation is more common in squamous cell carcinoma and especially in ADC solid variant. However, it is predicted that the prognostic significance of p53 and Ki-67 proteins may provide more meaningful results in larger patient groups and long-term follow-up.

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