Aslıhan KARUL, Serdar ŞEN, Ekrem ŞENTÜRK, Salih ÇOKPINAR, Ertan YAMAN, Nilgün KUMAN KANLIOĞLU

Bronchial cytokine level changes in lung cancer operations

Amaç: Bu çalışmada akciğer rezeksiyon tipinin, lenfovasküler invazyonun ve kanser türünün bronşiyal sitokin düzeyleri üzerine [interlökin (IL)-6, IL-8 ve tümör nekroz faktör-alfa (TNF-a)] etkileri değerlendirildi.Çalışmaplanı:Ağustos 2010 - Aralık 2011 tarihleri arasında akciğer kanseri nedeniyle akciğer rezeksiyonu uygulanan 28 hasta (27 erkek, 1 kadın; ort yaş 65.9±7.6 yıl; dağılım 48-79 yıl) çalışmaya alındı. Hiçbirinde ateş, ampiyem veya alt solunum yolu enfeksiyonu bulguları yoktu. Bronş lavajı örnekleri hemen ameliyat öncesi ana bronş sistemlerinin her iki tarafından ve hemen ameliyat sonrası ameliyat edilen ana bronştan toplandı.Bul gu lar: Ameliyat öncesi her iki bronşiyal bölgeden alınan bronş sitokinleri arasında (tümörü olan ve olmayan) anlamlı farklılık gözlenmedi. Tümör tarafı bronşiyal IL-6 ve TNF-a düzeyleri ameliyat öncesi düzeyler (p=0.001, p=0.045) ile karşılaştırıldığında, ameliyat sonrası anlamlı ölçüde artmıştı. Pnömonektomi uygulanan hastalarda IL-6 düzeyleri lobektomiye kıyasla yüksek bulundu (p=0.004). İlave bir cerrahi işlem olarak dekortikasyon yapılan hastalar ile izole sadece akciğer rezeksiyonu uygulanan hastaların ameliyat öncesi kontralateral bronşiyal IL-8 düzeyleri arasında anlamlı farklılık gözlendi (p=0.017). Evre, evre alt grubu ile ameliyat öncesi kontralateral bronşiyal IL-6 düzeyi (p=0.005, p=0.027) arasında pozitif ilişki vardı. Ameliyat sonrası IL-6 düzeyleri lenfovasküler invazyon saptanan (p=0.008) hastalarda daha yüksek bulundu.So nuç: Ameliyat sonrası bronşiyal sistem tümör tarafı bronşiyal sitokin IL-6 ve TNF-a düzeyleri cerrahi travmanın bir göstergesi olabilir. Tümör evresi arttıkça, tüm akciğer etkilenir ve enflamatuvar yanıt kontralateral hemitoraksa kadar yayılır. Ameliyat sonrası IL-6 düzeyleri lenfovasküler invazyonun bir göstergesi olabilir. Ameliyatın büyüklüğüne göre enflamatuvar yanıt etkilenmektedir; pnömonektomi uygulanan hastaların IL-6 düzeyleri lobektomilere kıyasla anlamlı düzeyde yüksek seyredebilir. Bu sonuç, IL-6 sentezi ve cerrahi travma derecesi arasındaki ilişkiyi göstermektedir.

Akciğer kanser ameliyatlarında bronşiyal sitokin düzeylerindeki değişiklikler

Background: This study aims to evaluate effects of lung resection type, lymphovascular invasion and type of cancer on bronchial cytokine levels [interleukin (IL)-6, IL-8 and tumor necrosis factor- alpha (TNF-a)]. Methods: Twenty-eight patients (27 males, 1 female; mean age 65.9±7.6 years; range 48 to 79 years) with lung cancer undergoing lung resection between August 2010 and December 2011 were enrolled in the study. None had fever, empyema or signs of lower respiratory tract infection. Bronchial lavage samples were collected from both sides of main bronchial systems right before the operation and from the operated bronchus right after the operation. Results: No significant difference was observed between preoperative bronchial cytokines of both bronchial sites (with and without tumor). Tumor-side bronchial IL-6 and TNF-a were significantly increased after the operation compared to preoperative levels (p=0.001, p=0.045). Compared to lobectomy, IL-6 levels of the patients who underwent pneumonectomy were significantly higher (p=0.004). Significant difference was observed between preoperative contralateral bronchial IL-8 levels of patients in whom decortication was performed as an additional operational procedure and those underwent an isolated lung resection (p=0.017). There was a positive correlation between stage, stage subgroup, and preoperative contralateral bronchial IL-6 levels (p=0.005, p=0.027). Postoperative IL-6 levels were found to be higher in patients with lymphovascular invasion (p=0.008). Conclusion: Bronchial cytokines, IL-6 and TNF-a levels, were markers of surgical injury on the tumor side from bronchial system following operation. As the tumor stage increases, the entire lungs are affected and the inflammatory response is expanded to contralateral hemithorax. Postoperative IL-6 levels may be an indicator of lymphovascular invasion. The extensiveness of the operation also affects the inflammatory response; IL-6 levels of the patients undergoing pneumonectomy may have significantly higher than lobectomy. Thus, it shows a relationship between IL-6 synthesis and the degree of surgical injury.

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