Alpaslan MAYADAĞLI, Elif TORUN, Taflan SELEPÇİ, Banu SALEPÇİ, Ali FİDAN, Benan ÇAĞLAYAN

Küçük hücreli akciğer kanserinde prognostik faktörler

Küçük hücreli akciğer kanseri (KHAK)’nde prognostik faktörleri ve tedavi sonuçlarını belirlemek amacıyla bir yıl süresince kliniğimizde histopatolojik olarak KHAK tanısı konan 40 hasta prospektif olarak değerlendirildi. Tüm hastalarda hikaye ve fizik muayenenin ardından ECOG skalasına göre performans skoru belirlendi, hastaların akciğer grafisi ve toraks bilgisayarlı tomografisi (BT) çekildi. Tam kan sayımı ve geniş biyokimya analizleri yapıldı, tümör belirteçlerine bakıldı. Metastaz taraması için batın ultrasonografi (USG) ya da BT, kemik sintigrafisi, kranial BT ya da manyetik rezonans (MR) ve kemik iliği biyopsisi uygulandı. Sınırlı evrede tanı konan hastalara kemoterapi ve torasik radyoterapi, yaygın evredeki hastalara ise kemoterapi uygulandı. Hastaların 19’u sınırlı, 21’i yaygın hastalık olarak evrelendirildi. Laboratuvar bulgularının evreler arası farkları değerlendirildiğinde LDH, SGOT ve GGT düzeylerinin yaygın evrede anlamlı olarak daha yüksek olduğu görüldü (sırasıyla p= 0.005, 0.015, 0.001). Tüm hastalar değerlendirildiğinde median sağkalım 6 ± 1 ay, altı aylık kümülatif sağkalım %39.47, 12 aylık kümülatif sağkalım %20.72 olarak saptandı. Sınırlı evrede median sağkalım 10 ± 2 ay, yaygın evrede 3 ± 1 ay olarak saptandı, bu fark istatistiksel olarak anlamlıydı. LDH, CA15-3, GGT ve SGOT yüksekliği, hipoproteinemi ve kötü performans skoru univaryate analizlerde kötü prognostik faktörler olarak saptansa da (sırasıyla p= 0.024, 0.032, 0.047, 0.013, 0.021 ve 0.013), multivaryate analizlerle hiçbirinin bağımsız prognostik faktör olduğu gösterilemedi. Diğer kan tetkikleri, plevral sıvı varlığı, yaş, mediastinal lenf nodu tutulumu ve kilo kaybı prognostik faktör olarak bulunmadı. Univaryate analizlerle prognostik faktör olarak saptanan evre, multivaryate analizlerle de bağımsız prognostik faktör olarak saptandı (p= 0.045).

Prognostic factors in small cell lung cancer

In order to find out prognostic factors and treatment results in small cell lung cancer (SCLC), 40 patients diagnosed in one year period were prospectively analysed. Following history and physical examination, patients were grouped according to ECOG performance scale and underwent Chest X-ray and thoracic computerized tomography (CT). Complete blood count, biochemical analyses, tumor markers were taken. Abdominal USG or CT, bone scintigraphy, cranial CT or MRI and bone marrow biopsy were made for detection of metastases. Limited stage patients received chemotherapy and thoracic RT, whereas cases with extensive disease received chemotherapy. Nineteen cases had limited and 21 had extensive disease. When laboratory findings between 2 stages were compared, LDH, SGOT and GGT were significantly higher in extensive stage (p= 0.005, 0.015, 0.001, respectively). Overall median survival was 6 ± 1 months, cumulative survival in 6 and 12 months were 39% and 20.72%, respectively. Median survival was 10 ± 2 months in limited stage and 3 ± 1 months in extensive stage, with a statististically significant difference. Univariate analyses showed that incresed LDH, CA15-3, GGT and SGOT levels, hipoproteinemia and poor performance scale were poor prognostic signs (p= 0.024, 0.032, 0.047, 0.013, 0.021 ve 0.013, respectively), however multivariate analyses revealed no significant difference. Other blood tests, pleural effusion, age, mediastinal lymph node metastases and weight loss had no prognostic effect. Stage was found to be prognıostic factor with both univariate and multivariate analyses (p= 0.045).

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1. Fraser RS, Müller NL, Colman N, Pare PD. Diagnosis of Diseases of the Chest Pulmonary Carcinoma. 4th ed. Philadelphia, 1999: 1070-228.
2. Engin K, Özyardımcı N. Akciğer Kanserleri-Tanı ve Tedavide Temel İlkeler ve Uygulamalar. 1. Baskı. İstanbul, 2001: 135-83.
3. Oken MM, Creec RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-55.
4. Fishman AP, Elias JA, Fishman JA, et al. Small cell lung cancer: Diagnosis, treatment and natural history. In: Johnson DH, Blanke CD (eds). Pulmonary Diseases and Disorders. 3rd ed. New York, 1998: 1819-31.
5. Arriagada R, Le Chevalier T, Pignon JP, et al. Initial chemotherapeutic doses and survival in patients with limited small cell lung cancer. N Engl J Med 1993; 329: 1848-52.
6. Schiller JH. Küçük hücreli ve küçük hücreli dışı akciğer kanseri tedavisindeki güncel standartlar. Oncology 2001; 61(Suppl 1): 3-13.
7. Osterlind K. LDH or NSE or LDH and NSE as pretreatment prognostic factors in small call lung cancer. Lung Cancer 2000; 30: 51-3.
8. Aisner J. Extensive disease small cell lung cancer: The thrill of victory; the agony of defeat. J Clin Oncol 1996;14: 658-65.
9. Wurschmidt F, Bunemann H, Heilmann HP. Small cell lung cancer with and without superior vena cava syndrome: A multivariate analysis of prognostic factors in 408 cases. International Journal of Radiation Oncology, Biology, Physics 1995; 33: 77.
10. Clark R, Ihde DC. Small cell lung cancer: Treatmet progress and prospects. Oncology 1998; 12: 647-58.
11. Turrisi A, Kim K, Blum, et al. Twice daily compared with once-daily thoracic radiotherapy in limited stage small cell lung cancer treated concurrently with cisplatin and etoposide N Engl J Med 1999; 340: 265-71.
12. Lassen UN, Osterlind K, Hirsch FR, et al. Early death during chemotherapy in patients with small cell lung cancer: Derivation of a prognostic index for toxic death and progression. Br J Cancer 1999; 79: 515.
13. Lung Cancer: Principles and practice. Pass HI, Mitchell JB, Johnson DH, Turrisi AT, Minna JD. 2000. Philadelphia. Classification, Histology, Cytology and Electron microscopy.463.
14. Maestu I, Pastot M, Gomez-Codina J, et al. Pretreatment prognostic factors for survival in small cell lung cancer: A new prognostic index and validation of three known prognostic indices on 341 patients. Ann Oncol 1997; 8: 547.
15. Lassen U, Osterlind K, Hansen M, et al. Long term survival in small cell lung cancer: Posttreatment characteristics in patients surviving 5 to 18+ years-an analysis of 1714 consecutive patients. J Clin Oncol 1995; 13: 1215.
16. Jeremic B, Shibamoto Y, Acimovic L, Milisavljevic. Initial versus delayed accelerated hyperfractionated radiation therapy and concurrent chemotherapy in limited small cell lung cancer: A randomised study. J Clin Oncol 1997;15: 893-900.
17. Ray P, Quantin X, Grenier J, Pujol JL. Predictive factors of tumor response and prognostic factors of survival during lung cancer chemotherapy. Cancer Detect Prev 1998; 22: 293-304.
18. Rawson NS, Peto J. An overview of prognostic factors in small cell lung cancer. A report from the Subcommittee for the Management of Lung Cancer of the United Kingdom Coordinating Committee on Cancer Research. Br J Cancer 1990; 61: 597-604.
19. Johnson DH, Windham WW, Allen JH, Greco FA. Limited value of CT brain scans in staging of small cell lung cancer. Am J Roentgenol 1993; 140: 37-40.
20. Gregor A, Drings P, Burghouts J, et al. Randomized trial of alternating versus sequential radiotherapy/chemotherapy in limited-disease patients with small cell lung cancer: A European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group Study. J Clin Oncol 1997; 15: 2840-9.
21. Laurie SA, Logan D, Markman BR, Mackay JA, Evans WK; Lung cancer disease site group of care Ontario’s program in evidence-based care. Practice guideline for the role of combination chemotherapy in the initial management of limited stage small cell lung cancer. Lung Cancer 2004; 43: 223-40.