Gül KANYILMAZ, Meryem AKTAN, Berrin BENLİ YAVUZ, Lütfi Saltuk DEMİR

Evre III küçük hücre dışı akciğer kanserli hastalarda sekizinci evreleme sisteminin prognostik etkileri

Amaç: Ocak 2017’ de akciğer kanserinin tümör, nod ve metastaz (TNM) evreleme sınıflamasının 8. versiyonu yayımlanmıştır. Bu araştırmada evre III küçük hücreli dışı akciğer kanseri (KHDAK) tanısıyla küratif kemoradyoterapi (KRT) uygulanan hastalarda 7. ve 8. evreleme sisteminin etkilerini karşılaştırmak ve gruplar arasındaki sağkalım farkını incelemek amaçlanmıştır. Gereç ve Yöntemler: Ocak 2010 ve Ocak 2017 tarihleri arasında KHDAK tanısıyla başvuran hastalardan klinik evre III kabul edilerek küratif KRT uygulanan hasta verileri geriye dönük incelendi. 8. versiyona göre olan T-evre ve TNM evre değişimleri kaydedildi. Eski ve yeni T-evre, N-evre ve TNM evre kategorilerine göre sağkalım analizleri yapıldı.Bulgular: Toplam 112 evre III KHDAK’li hastanın değerlendirildiği çalışmada 33 hastanın (%30) T-evresinde değişme saptanırken, 47 (%42) hastanın TNM evresinde değişiklik olmuştur. İleri yaş, takip sırasında uzak organ metastazı gelişmesi, TNM evresi ve N-evresi sağkalımı etkileyen bağımsız prognostik faktörler olarak bulunmuştur. Sonuç: Sekizinci TNM evreleme sınıflamasına göre tümör boyutu alt gruplara bölünerek T-evresinin yeniden sınıflandırılması lokal ileri evre KHDAK’li hastalarda sağkalımı etkileyen bir parametre olarak bulunmamıştır. Evre IIIa ve IIIc hastalar arasında anlamlı, evre IIIa ve IIIb hastalar arasında anlamlılığa yakın bir sağkalım farkı bulunmasına rağmen evre IIIb ve IIIc hastalar arasında anlamlı sağkalım farkı bulunamamıştır. N3 hastalığa sahip olmak tek başına sağ kalımı öngörecek bağımsız prognostik bir faktör olarak saptanmıştır.

Anahtar Kelimeler:

küçük hücreli dışı akciğer kanseri, prognostik faktörler, radyoterapi, evreleme

The prognostic effects of new eighth staging system for stage III non-small cell lung cancer

Aim: The eighth tumour, node and metastasis (TNM) staging system for lung cancer was published in January 2017. To compare the newly released 8thversion of TNM staging system with 7th version of TNM staging system in stage III non-small cell lung cancer patients (NSCLC) treated with curative chemo-radiotherapy (CRT) and to evaluate the survival differences between the groups were the aims of this study.Material and Methods: Between January 2010 and January 2017, stage III NSCLC patients who were treated with curative CRT were identified retrospectively. Changes in T-stage and TNM-stage were according to 8thstaging system were recorded. Survival analysis were performed by using T-stage, N-stage and TNM stage in each staging system, respectively.Results: One hundred and twelve patients were included in this study. Of these 33 patients (30%) showed change in T-stage, whereas 47 patients (42%) had change in TNM stage. Advanced age, distant organ metastasis during follow-up, TNM stage and N-stage progression was found as independent prognostic factors affecting survival. Conclusion: According to 8th TNM staging system, subdivision of T-stage by tumour size did not affect the survival parameters in locally advanced NSCLC patients. On the other hand, we found significant survival difference between stage IIIa and IIIc. In regards of survival, although there was a significant difference between patients with IIIa and IIIc, and almost significance between patients with IIIa and IIIb, there was no significance between stage IIIb and IIIc patients. Having N3 nodal disease was found to be an independent prognostic factor of survival.

Keywords:

non-small cell lung cancer, prognostic factors, radiotherapy, staging,

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