Sulhattin ARSLAN, Sefa Levent ÖZŞAHİN, Şule KARADAYI, İbrahim AKKURT, Ekber ŞAHİN

Akciğer kanserli hastalarda venöz tromboembolizm riski

Amaç: Akciğer kanseri olan hastalarda venöz tromboemboli insidansı tespit edildi, venöz tromboemboli ile kanserin histopatolojik tiplendirmesi, evresi, tedavisi ve eşlik eden kronik hastalıklar arasındaki ilişkiler değerlendirildi.Çalışma planı: Ocak 2006 - Mayıs 2009 tarihleri arasında kliniğimizde tanı ve tedavisi yapılan ve dosya verilerine ulaşılabilen 137 akciğer kanserli hasta (126 erkek, 11 kadın; ort. yaş 58±28 yıl; dağılım 24-78 yıl) geriye dönük olarak planlanan bu çalışmaya alındı. Venöz tromboembolinin tanısı için klinik bulgular, toraks bilgisayarlı tomografi-anjiyografi, ventilasyon-perfüzyon sintigrafisi ve Doppler ultrasonografi bulguları esas alındı. Tromboze ven adı kaydedildi.Bulgular: Hastaların %8.8'inde venöz tromboemboli tespit edildi. Sigara içen 121 hastanın %9.1'inde venöz tromboemboli vardı. Hastaların %44.6'sında başka hastalıklar var idi. Bazı hastalarda birden fazla eşlik eden hastalık (kronik obstrüktif akciğer hastalığı, arteryel hipertansiyon, koroner arter hastalığı, diyabetes mellitus, konjestif kalp yetmezliği) var idi. Venöz tromboembolili hastalarda eşlik eden hastalık görülme oranı yaklaşık %58.3 idi. Hastaların %22.6'sı küçük hücreli akciğer kanseri, %77.4'ü küçük hücreli dışı akciğer kanseri idi. Venöz tromboemboli, küçük hücreli akciğer kanserli hastaların %6.4'ünde, küçük hücreli dışı akciğer kanserli hastaların ise %9.4'ünde tespit edildi. Histopatolojik olarak tromboembolili hastaların %50'sinde adenokanser tespit edildi. Kanser olan hastaların %58.3'ü ileri evre idi ve yine kanserli hastaların %58.3'ünde birinci basamak tedavi sırasında venöz tromboemboli gelişti. Hastaların %53.8'inde metastaz bulunmakta idi.Sonuç: Her ne kadar istatistiksel olarak anlamlı olmasa da venöz tromboemboli görülme oranı, adenokarsinomlu, ileri evre kanserli, metastaz yapmış ve kronik komorbiditesi olan grupta daha yüksek idi. Bu oran kemoterapi uygulanan hastalarda da hafif bir şekilde yüksek idi.

Venous thromboembolism risk in patients with lung cancer

Background: The incidence of venous thromboembolism in lung cancer patients was investigated and the relationships between venous thromboembolism and histopathological types, stage, and treatment of the cancer, as well as accompanying chronic diseases were evaluated.Methods: This retrospective study was based on the evaluation of the files of 137 lung cancer patients (126 males, 11 females; mean age 58±28 years; range 24 to 78 years), who were diagnosed and treated in our clinic between January 2006 and May 2009. The diagnosis of venous thromboembolism was based on the clinical findings and the findings of the thorax computed tomography-angiography, ventilationperfusion scintigraphy, and Doppler ultrasound. The name of the thrombosed vein was recorded.Results: Venous thromboembolism was determined in 8.8% patients. Of 121 smokers, 9.1% had venous thromboembolism. Other diseases were present in 44.6% of patients. Some patients had more than one accompanying disease (chronic obstructive lung disease, arterial hypertension, coronary artery disease, diabetes mellitus, congestive heart failure). The incidence rate of accompanying diseases in the patients with venous thromboembolism was 58.3%. Of the patients, 22.6% had small cell lung cancer, while 77.4% had non-small cell lung cancer. Venous thromboembolism was present in 6.4% of the patients with small cell lung cancer, and in 9.4% of the patients with nonsmall cell lung cancer. Histopathologically, adenocarcinoma was detected in 50% of the patients with venous thromboembolism. The cancer in 58.3% of the patients with venous thromboembolism was in its advanced stage, and the cancer in 58.3% of the patients developed venous thromboembolism during first step treatment. Metastasis was noted in 53.8% of patients.Conclusion: Although the differences were not statistically significant, the incidence rate of venous thromboemboli was higher in the group of patients with adenocarcinoma, advanced stage cancer, metastasis, and chronic comorbidity. It is also slightly higher in patients who were administered chemotherapy.

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