Arife ZEYBEK, Abdullah ERDOĞAN, Alpay SARPER, Levent DERTSİZ, Abid DEMİRCAN, Hakan KESKİN

Küçük hücreli dışı akciğer karsinomlarında preoperatif metastatik alt mediastinal lenf nodlarının saptanmasının sağkalım üzerinde prognostik etkisi

Amaç: Çalışmamızda küçük hücreli dışı akciğer kanserli olgularda preoperatif klasik servikal mediastinoskopi ile evrelendirilemeyen inferior mediastinal lenf nodlarının diğer mediastinal lenf nodları ile karşılaştırmalı sağkalım analizi ve inferior mediastinal lenf nodlarına metastaz yapan tümörlerin en sık hangi lokalizasyonda bulunduğunu inceledik. Yöntemler: Küçük hücreli dışı akciğer kanseri nedeni ile küratif amaçla opere edilen 487 olgunun epikriz ve patoloji raporları retrospektif olarak incelendi. Alt mediasten lenf nodu tutulumu ile birlikte baskın tümör lokalizasyonu araştırıldı.Bulgular: Küratif rezeksiyon uygulanan hastaların 56’sında patolojik değerlendirme sonucu mediastinal lenf nodu pozitifliği raporlandı. Bu hastaların 36’sında inferior mediastinal lenf nodu tutulumu saptandı. İnferior mediastinal lenf nodu metastazı olan hastaların, ortalama sağkalım süresi 41,72 ay 5 yıllık sağkalım %36,1 aydır. Diğer N2 ’lerle karşılaştırıldığında, inferior mediastinal lenf nodu tutulumu olanlarda sağkalım süresinin daha iyi olduğu, ancak bu farkın istatistiksel olarak anlamlı olmadığı saptandı. İnferior mediastinal lenf nodlarına en sık metastaz yapan tümör lokalizasyonun alt lob lokalizasyonlu tümörler olduğu ve üst lob lokalizasyonlu tümörlerle bu açıdan karşılaştırıldığında farklılık istatistiksel olarak anlamlı saptandı. Sonuç: Alt lob tümörlerinde preoperatif noninvaziv ve invaziv yöntemlerle inferior mediastinal lenf nodlarının belirlenmesi hastaların sağkalımı açısından daha faydalıdır. Ancak geniş vaka serileri ve prospektif çalışmalara ihtiyaç vardır.

The prognostic impact of the detection of metastatic inferior mediastinal lymph node in non- small cell lung cancer at preoperative term

Objective: In our study, we reviewed the survival of patients operated for non-small cell lung cancer (NSCLC) and had positive inferior mediastinal lymph nodes that couldn’t be staged with mediastinoscopy prior to surgery in comparison to other mediastinal lymph node involvement, the localization of tumors that metastasize to inferior mediastinal lymph nodes. Methods: 487 cases operated for NSCLC were reviewed retrospectively. The predominant localization of the tumors with inferior mediastinal lymph node involvement was investigated. Results: Among the cases that were completely resected, 56 cases were reported to be pathologically mediastinal lymph node involvement. Among these patients, there were 36 patients with inferior mediastinal lymph node involvement, the survival of which were compared to the survival of patients with involvement in other mediastinal lymph node stations involvement. The patients with inferior mediastinal lymph node involvement had a mean survival time of 41.72 months, 5 years survival rate of 36.1%. When compared to other patients N2 involvement, survival was better in inferior mediastinal lymph node involvement, although the difference was not statistically significant. The tumor localization that metastasizes most frequently to the inferior mediastinal lymph nodes are the lower lobes. Compared to the upper lobes the difference is statistically significant. Conclusion: In tumors of the lower lobes, there are benefits to invasive and non-invasive staging of inferior mediastinal lymph nodes in terms of patient survival. Further studies with large case series are needed.

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