Tevfik İlker AKÇAM, Kenan Can CEYLAN, Onur AKÇAY, Ozan USLUER, Özgür SAMANCILAR, Şeyda ÖRS KAYA

Erken evre ameliyat edilen küçük hücreli dışı akciğer kanserli hastalarda tümör hacmi sağkalıma etkili midir?

Amaç: Bu çalışmada erken evre ameliyat edilen küçük hücreli dışı akciğer kanserli hastalarda tümör hacminin sağkalımı etkileyip etkilemediği araştırıldı. Çalışma planı: Eylül 2009 - Haziran 2013 tarihleri arasında anatomik rezeksiyon ve mediastinal lenf bezi diseksiyonu yapılan küçük hücreli dışı akciğer kanserli 156 hasta (146 erkek, 10 kadın; ort. yaş 62.3±8.0 yıl; dağılım 38-79 yıl) retrospektif olarak incelendi. Tümör hacimleri histopatolojik veriler kullanılarak hesaplandı. Tümör hacminin prognoz ve sağkalım üzerindeki etkisi araştırıldı. Bulgular: Hastaların 116’sında Evre I ve 40’ında Evre II hastalık var idi. Ortalama tümör hacmi 38.2±54.6 (dağılım; 356.15- 0.01) cm3 iken, ortalama en büyük çap 4.2±2.0 (dağılım; 10-0.3) cm idi. Cox- regresyon analizinde eşik değerin altında tümör hacmi (29.69 cm3) 2 olasılık oranı (OR) ile sağkalımı artırmakla birlikte, bu değer istatistiksel olarak anlamlı idi (p=0.022). T faktörüne göre eşik değer 4.5 cm olup, OR=1.7 idi; ancak, sağkalım ile arasında anlamlı bir ilişki gözlenmedi (p=0.058). Sonuç: Bu çalışmada en büyük tümör çapı ve sağkalım arasındaki bilinen ilişkinin aksine, tümör hacmi ile sağkalım arasında daha yakın bir ilişki saptandı. Çalışma bulgularımıza göre, akciğer kanseri evrelemesinde tümör çapı ile beraber tümör hacminin hesaplanması ve göz önünde bulundurulması önerilmektedir.

Does tumor volume affect survival in patients with operated early-stage non-small-cell lung cancer?

Background: This study aims to investigate whether tumor volume affects survival in patients with operated early-stage non-small-cell lung cancer.Methods: A retrospective analysis of 156 patients (146 males, 10 females; mean age 62.3±8.0 years; range 38 to 79 years) with non -small-cell lung cancer who underwent anatomical resection and mediastinal lymph node dissection between September 2009 and June 2013 was performed. The tumor volumes were calculated using histopathological data. The effect of tumor volume on prognosis and survival was investigated.Results: Of the patients, 116 had Stage I disease and 40 patients had Stage II disease. The mean tumor volume was 38.2±54.6 (range, 356.15 to 0.01) cm3, and the mean largest diameter was 4.2±2.0 (range, 10 to 0.3) cm. In the Cox regression analysis, the tumor volume below the cut- off value (29.69 cm3) increased survival with an odds ratio (OR) of 2, and this value was statistically significant (p=0.022). The cut- off value per T factor was 4.5 cm and the OR was 1.7; however, no significant correlation with the survival was observed (p=0.058).Conclusion: The present study found a closer correlation between the tumor volume and survival in contrast to the known correlation between the tumor’s largest diameter and survival. Based on our study results, it is recommended to calculate and consider the tumor volume along with the tumor diameter in the staging of lung cancer.

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17. Rami-Porta R, Ball D, Crowley J, Giroux DJ, Jett J, Travis WD, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2007;2:593-602.
16. Sridhar P, Mercier G, Tan J, Truong MT, Daly B, Subramaniam RM. FDG PET metabolic tumor volume segmentation and pathologic volume of primary human solid tumors. AJR Am J Roentgenol 2014;202:1114-9.
15. Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta -analysis. JAMA 2001;285:914-24.
14. Detterbeck FC, Falen S, Rivera MP, Halle JS, Socinski MA. Seeking a home for a PET, part 2: Defining the appropriate place for positron emission tomography imaging in the staging of patients with suspected lung cancer. Chest 2004;125:2300-8.
13. Soydal C, Yüksel C, Küçük NÖ, Okten I, Ozkan E, Doğanay Erdoğan B. Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Esophageal Cancer Patients. Mol Imaging Radionucl Ther 2014;23:12-5.
12. Chandrachud LM, Pendleton N, Chisholm DM, Horan MA, Schor AM. Relationship between vascularity, age and survival in non-small-cell lung cancer. Br J Cancer. 1997;76:1367-75.
11. Jefferson MF, Pendleton N, Faragher EB, Dixon GR, Myskow MW, Horan MA. ‘Tumour volume’ as a predictor of survival after resection of non-small-cell lung cancer (NSCLC). Br J Cancer 1996;74:456-9.
10. Vallières E, Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, et al. The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2009;4:1049-59.
9. Mountain CF. The relationship of prognosis to morphology and the anatomic extent of disease: studies of a new clinical staging system. In: Israel L, Chahinian AP, editors. Lung Cancer, Natural History, Prognosis, and Therapy. New York: Academic Press; 1976. p. 107-40.
8. Mountain CF, Carr DT, Anderson WA. A system for the clinical staging of lung cancer. Am J Roentgenol Radium Ther Nucl Med 1974;120:130-8.
7. Icard P, Heyndrickx M, Galateau-Salle F, Rosat P, Lerochais JP, Gervais R, et al. Does bilobectomy offer satisfactory long-term survival outcome for non-small cell lung cancer? Ann Thorac Surg 2013;95:1726-33.
6. Massard G, Dabbagh A, Dumont P, Kessler R, Roeslin N, Wihlm JM, et al. Are bilobectemies acceptable procedures? Ann Thorac Surg 1995;60:640-5.
5. Goldstraw P, Crowley JJ: The International Association for the Study of Lung Cancer international staging project on lung cancer. J Thorac Oncol 2006;1:281-6.
4. Işıtmangil T. The IASLC lung cancer staging Project: proposals for the forthcoming Seventh Edition of the TNM classification of non-small cell lung cancer. Turk Gogus Kalp Dama 2008;16:58-64.
3. Işıtmangil T, Balkanlı K. Lung cancer staging. In: Yüksel M, Kalaycı G, editörler. Thoracic Surgery. İstanbul: Bilmedya Group; 2001. s. 161-202.
2. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest 2009;136:260-271.
1. Bailey JE. Lung cancer susceptibility genes. In: Roth JA, Cox JD, Hong WK, editors. Lung Cancer. 3th ed. Texas: Blackwell Publishing; 2008. p. 20-33.