İleri evre küçük hücreli dışı akciğer kanserli hastalarda beyin metastazları için risk faktörleri

Bu çalışmanın amacı; ileri evre küçük hücreli dışı akciğer kanserli hastalarda (KHDAK) beyin metastazı için risk faktörlerini belirlemektir. Yüz altmış üç ileri evre KHDAK’li hastaların dosya kayıtları retrospektif olarak incelendi. İzlemleri sırasında beyin metastazı gelişen ve gelişmeyen olmak üzere 2 gruba ayrıldı. Yaş, cinsiyet, performans durumu, kilo kaybı, histopatolojik tip, primer tümörün lokalizasyonu, sigara içme öyküsü, tedavi yanıtı ve tanı anındaki laboratuvar tetkiklerinden laktat dehidrogenaz (LDH), albumin, hemoglobin düzeyleri univaryant ve multivaryant analize alındı. Cox proportional hazard modeli ve Kaplan-Meier sağ kalım analizleri SPSS 11.0 kullanılarak yapıldı. İzlemleri sırasında hastaların 40’ında (%24.5) beyin metastazı gelişti. Beyin metastazını etkileyen faktörler kilo kaybı, ekstrakraniyal metastaz varlığı, tedaviye yanıtın olmaması, primer tümörün üst lob yerleşimli olması, mediastinal lenf nodu tutulumu ve LDH yüksekliği olarak tespit edildi. Tüm grupta ortanca sağ kalım süresi 44 hafta, 1 yıllık sağ kalım oranı %38, beyin metastazı gelişinceye kadar geçen süre 32 hafta, beyin metastazı tanısından sonra ortanca sağ kalım süresi 28 hafta idi. Kilo kaybı, ekstrakraniyal metastaz varlığı, tedaviye yanıtın olmaması, primer tümörün üst lob yerleşimli olması, mediastinal lenf nodu tutulumu ve LDH yüksekliği beyin metastazını belirleyen en önemli faktörlerdir. Profilaktik kraniyal radyoterapi bu grup hastalarda beyin relapsını geciktirmek, yaşam kalitesini düzeltmek ve beyin metastazının mortalite ve morbiditesini azaltmak için düşünülebilir.

Isk factors for brain metastases in patients with advanced non- small cell lung cancer

We aimed to determine the risk factors for brain metastases among patients with advanced NSCLC. A retrospective analysis was made for 163 advanced NSCLC patients. The patients were enrolled into two groups in terms of who developed brain metastases or not during follow-up. Age, gender, performance status, weight-loss, histopathologic type, localisation of the primary tumor, smoking status, response to treatment, and lactate dehydrogenase (LDH), albumin, heamoglobin levels at the time of the diagnosis were analyzed by univariate and multivariate analysis. Cox proportional hazard model and Kaplan-Meier survival analysis.There were 40 (24.5%) patients who had brain metastases at the follow-up. Risk factors for brain metastases were weight-loss, extracranial metastases, upper localisation of primary tumor, unresponsiveness of first-line chemotherapy regimen, mediastinal lymph node involvement and high LDH level. Median survival was 44 weeks, overall survival rate at 1 year was 38%, median time to onset of brain metastases was 32 weeks and median survival from the diagnosis of brain metastases was 28 weeks. Weight-loss, extracranial metastases, upper localisation of primary tumor, unresponsiveness of first-line chemotherapy regimen, high LDH level and mediastinal lymph node involvement were the most important risk factors for the prediction of brain metastases. Prophylactic cranial irradiation may be choise in those patients to delay brain relapse, to improve quality of life and to decrease morbidity and mortality of brain metastases.

Kaynakça

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