Ahmet Emin ERBAYCU, Soner GÜRSOY, Ahmet ÜÇVET, Ozan USLUER, Şeyda KAYA ÖRS, Hakan KOPARAL

Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy

Amaç: Bu çalışmada, kemoterapi veya radyoterapi sonrası cerrahi rezeksiyon uygulanmış pT0/T1N0/M0 küçük hücreli dışı akciğer kanserli hastalarda sağkalım ve nüks oranları değerlendirildi ve pozitron emisyon tomografisi/bilgisayarlı tomografinin ameliyat öncesi değerlendirmedeki rolü araştırıldı.Ça lış ma pla nı: İndüksiyon tedavisi almış ve akciğer rezeksiyonu sonrası pT0N0 (n=25) ve pT1N0 (n=29) oldukları kanıtlanmış lokal ileri evre küçük hücreli dışı akciğer kanserli 54 hasta (52 erkek, 2 kadın; ort. yaş 59.2 yıl; dağılım 42-77 yıl) çalışmaya alındı. Hastalar torasik bilgisayarlı tomografi, bronkoskopi, respiratuvar fonksiyon testleri ile 18 hasta da ek olarak pozitron emisyon tomografisi/bilgisayarlı tomografi ile değerlendirildi. Rezeke edilemez kabul edilenler radyolojik bulgulara göre klinik olarak evrelendi. Rezeke edilebilir hastalığı ve N2 bulguları olanlarda histolojik onaylama için transbronşiyal iğne aspirasyonu biyopsisi, mediastinoskopi ve video yardımlı torakoskopik cerrahiyi içeren invaziv evreleme yöntemleri uygulandı.Bul gu lar: Ortalama izlem süresi 34.8 ay idi. Ortalama sağkalım süresi ve beş yıllık sağkalım oranları sırası ile T0 hastalarda 90.8 ay ve %86.3, T1 hastalarda 62.6 ay ve %53.7 idi. Nüks oranları T0 hastalarda anlamlı olarak daha düşük idi (p=0.03). Ameliyat öncesi pozitron emisyon tomografisi/bilgisayarlı tomografinin duyarlılık, özgüllük, pozitif öngörü değeri ve negatif öngörü değeri sırası ile %78, %56, %64 ve %71 idi. T0 hastalarda negatif öngörü değeri ile T1 hastalarda pozitif öngörü değeri %100 idi. Doğruluk değerleri T0 ve T1 hastalarda (sırası ile %56 ve %78) benzer idi (p=0.3).So nuç: Kemoterapi veya radyoterapi sonrası akciğer rezeksiyonu geçirmiş ve lenf bezi metastazı olmayan pT0 ve pT1 küçük hücreli dışı akciğer kanserli hastaların sağkalım oranları, indüksiyon tedavisi olmadan cerrahi geçirmiş erken evre hastalarınki ile benzer idi. Canlı tümör hücrelerinin varlığını belirlemede pozitron emisyon tomografisi/bilgisayarlı tomografinin doğruluk değeri beklenenden düşük idi.

Neoadjuvan tedavi sonrası patolojik tam yanıtı olan küçük hücreli dışı akciğer kanserli hastaların uzun dönem sağkalım sonuçları

Background: This study aims to evaluate survival and recurrence rates in pT0/T1N0/M0 non-small cell lung cancer patients who underwent surgical resection after chemotherapy and/or radiotherapy, and investigate the role of positron emission tomography/computed tomography in preoperative evaluation.Methods: A total of 54 patients (52 males, 2 females; mean age 59.2±9.3 years; range 42 to 77 years) with locally advanced non-small cell lung cancer without lymph node metastasis who had induction therapy and were proven to be pT0N0 (n=25) and pT1N0 (n=29) after pulmonary resection were included in the study. Patients were evaluated with thoracic computed tomography, bronchoscopy, respiratory function tests, and 18 patients with positron emission tomography/computed tomography, additionally. Those considered to be unresectable were clinically staged according to radiological findings. Invasive staging methods including transbronchial needle aspiration biopsy, mediastinoscopy, and video-assisted thoracoscopic surgery were performed for histological confirmation in those with resectable disease and N2 findings.Results: Mean follow-up duration was 34.8 months. Mean survival duration and five-year survival rates were 90.8 months and 86.3% in T0 patients and 62.6 months and 53.7% in T1 patients, respectively. Recurrence rates were significantly lower in T patients (p=0.03). Sensitivity, specificity, positive predictive value, and negative predictive value of preoperative positron emission tomography/computed tomography were 78%, 56%, 64%, and 71%, respectively. Negative predictive value in T0 and positive predictive value in T1 patients was 100%. Accuracy values in T0 and T1 patients (56% and 78%, respectively) were similar (p=0.3).Conclusion: Survival rates in pT0 and pT1 non-small cell lung cancer patients, who underwent lung resection after chemotherapy and/or radiotherapy, were similar with those of early stage patients who underwent surgery without induction therapy. Accuracy value of positron emission tomography/computed tomography in determining the presence of viable tumor cells was lower than expected.

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