Nesrin SARIMAN, Atilla SAYGI, Alpay ÖRKİ, Dida MARAŞLI, Huri Özkan YILMAZ, Yeliz DÜZGÜN, Hülya KÖKSAL

Akciğer kanseri güncel klinik TNM evrelemesinde T evresi ile nodal metastaz arasındaki ilişki

Amaç: Bu çalışmada küçük hücreli dışı akciğer kanserinde (KHDAK), 6. tümör nodül metastaz (TNM) evreleme sistemi (eski) ile 7. TNM evreleme sistemi revizyon modelini (yeni) karşılaştırarak, klinik T (cT) evresi ile metastaz (M) arasındaki ilişkinin araştırılması ve evreleme değişikliğinin tedavide getirebileceği farklılıkların belirlenmesi hedeflendi. Çalışma planı: Ocak 2007 - Ocak 2009 tarihleri arasında KHDAK tanısı konulan 136 hastanın (123 erkek, 13 kadın; ort. yaş 60.8 yıl; dağılım 25-83 yıl) klinik verileri retrospektif olarak değerlendirildi. Hastaların yaş, cinsiyet, sigara alışkanlıkları, radyolojik veya bronkoskopik bulguları, tanı ve metastaz tarama teknikleri de dahil olmak üzere çeşitli değişkenler belirlendi. Klinik evreleme (cTNM) 6. TNM evreleme ile 7. TNM evreleme revizyon modeline göre yapıldı. Bulgular: Hastaların 41’inde (%30.1) skuamöz hücreli karsinom, 29’unda (%21.3) adenokarsinom, 66’sında (%48.5) tip ayrımı yapılamayan k üçük hücreli d ışı a kciğer kanseri saptandı. Yedinci TNM evreleme sistemi temelinde başlangıca göre 23 hastada evreleme değişti; 15’inde ise evre düşüşü oldu. En fazla değişikliğin evre 3A ve 3B’de olduğu, evre 1’de ise evrenin değişmediği görüldü. Altıncı TNM evreleme sistemine göre M dağılımı; 72 (%52.9) metastaz yapmamış, 64 (%47.1) metastaz yapmış olarak belirlendi. Yedinci evreleme sisteminde, M dağılımında metastaz yapmamış hastalık tanısı konulan hasta sayısı bir artarak, 73’e ulaştı (%53.6). Metastaz yapmış olan 63 hastanın 17’sinde (%12.5) intrapulmoner metastaz (M1a), 46’sında (% 33.9) ise uzak metastaz (M1b) saptandı. N dağılımına göre gruplar arasında anlamlı bir fark görülmedi. Yüz otuz altı hastanın on birinde (%8.1) tedavi yaklaşımı farklılaştı. Sonuç: Çalışmamızın sonuçlarına göre 6. ve 7. TNM evreleme sistemi karşılaştırıldığında iki sistem %96.9 oranında uyumlu bulundu (r=0.968; p

Relationship of T-stage and nodal metastases according to the up-to-date clinical TNM staging in lung cancer

Background: This study aims to evaluate the relationship between the clinical T (cT)-stage and metastases (M) in patients with nonsmall cell lung cancer (NSCLC), comparing the $6^{th}$ revised edition (old) and $7^{th}$ revised edition (new) of the TNM staging system and to assess the potential divergent effects of staging on the course of treatment. Methods: A retrospective analysis of 136 patients (123 males, 13 females; mean age 60.8 years; range 25 to 83 years) who were diagnosed with NSCLC between January 2007 and January 2009 were conducted. Several variables including age, gender, smoking status previous radiological and/or bronchoscopic findings, and diagnostic and screening techniques which were used to diagnose metastases were determined. Clinical staging (cTNM) was assessed using the $6^{th}$ and $7^{th}$ revised editions of the TNM staging system. Results: A total of 41 patients (30.1%) had squamous cell carcinoma, 29 (21.3%) had adenocarcinoma and 66 (48.5%) had histologically not otherwise specified NSCLC. Staging was changed for 23 of the patients, while lower stage of disease, compared to baseline, was found in 15 patients, based on the $7^{th}$ edition of TNM the staging system. The most significant changes were observed in stages 3A and 3B, whereas no difference was seen in stage 1 disease. According to the $6^{th}$ edition of TNM staging system in terms of M distribution, 72 (%52.9) had no metastases, whereas 64 (%47.1) had metastatic disease. According to the $7^{th}$ edition in terms of M distribution, one more patient was diagnosed with non-metastatic disease, increasing the number of the patient in this group up to 73 (53.6%). Of 63 patients with metastases, 17 (%12.5) had intrapulmonary metastases (M1a), while 46 (%33.9) had distant metastases (M1b). No significant difference was seen between the groups in terms of N distribution. Different treatment modalities were followed in 11 of 136 patients (8.1%). Conclusion: Our study results showed comparable results in both groups, including $6^{th}$ edition and $7^{th}$ edition of the TNM staging system, suggesting a concordance rate of 96.9% (r=0.968; p

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