Altuğ KOŞAR, Çağatay TEZEL, Bülent ARMAN, Yelda TEZEL, Ayşe ERSEV

The prognostic significance of histopathologic angioinvasion in stage I non-small cell lung cancer

Amaç: Çalışmamızda akciğer kanserinde prognozu etkileyen histopatolojik bulgulardan vasküler invazyonun, lenfatik yayılım yapmamış erken evre akciğer kanserindeki prognostik önemi araştırıldı.Çalışma planı: Aralık 1997-Ocak 2004 yılları arasında küratif mediastinal lenf nodu rezeksiyonu uygulanmış erken evre (T1-2N0M0) küçük hücreli dışı akciğer kanserli 40 hasta (32 erkek, 8 kadın; ort. yaş 53.8±8.7 yıl; dağılım 35-69 yıl) geriye yönelik olarak değerlendirildi. Tümör histolojisi, grade, vasküler invazyon ve rezeksiyon büyüklüğü çalışılan kriterlerdendi. Patoloji kesitleri yeniden incelendi ve en az iki vasküler yapının invazyonu ve/veya damar lümeninde tumoral tromboz bulunması vasküler invazyon olarak tanımlandı.Bulgular: Üç yıllık hastalıksız sağkalım %67.2±7.5, beş yıllık sağkalım ise %64.5±7.6 olarak hesaplandı. Vasküler invazyonun olup olmamasına göre değerlendirme yapıldığında genel sağkalım süreleri arasında anlamlı farklılık saptanmadı (Log rank: 0.85; p:0.357; p>0.05). Bununla birlikte, adenokarsinomlu olguların lokal nüks veya uzak metastaz nedeni ile kötü prognoz gösterdiği tespit edildi (p

Evre I küçük hücreli dışı akciğer kanserinde histopatolojik damar invazyonun prognostik önemi

Background: We aimed to analyze the prognostic significance of vascular invasion, which is one of the histopathological features affecting the prognosis in early stage lung cancers.Methods: Forty early stage (T1-2N0M0) non-small cell lung cancer patients (32 males, 8 females; mean age 53.8±8.7 years; range 35 to 69 years) who underwent curative surgery with mediastinal lymph node dissection between December 1997 and January 2004 were retrospectively evaluated. Tumor histology, grade, vascular invasion, and the extent of resections were evaluated. Pathological slides were re-examined and invasion of at least two vascular structures and/or presence of tumoral thrombosis in the lumen of vessels were defined as vascular invasion.Results: Three-year disease free survival was found to be 67.2±7.5% and five-year survival was 64.5±7.6%. When an evaluation was done considering whether there was vascular invasion or not, there was not a significant difference (Log rank: 0.85; p:0.357; p>0.05) However, adenocarcinoma subtype was found to be related with unfavorable outcome with high local relapses and distant metastases (p

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1) Ginsberg RJ, Vokes EE, Raben A. Cancer of the lung. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 849-950.
2) Levine MN, Browman GP, Gent M, Roberts R, Goodyear M. When is a prognostic factor useful? A guide for the perplexed. J Clin Oncol 1991;9:348-56.
3) Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin 2002;52:23-47.
4) Hilsenbeck SG, Raub WA Jr, Sridhar KS. Prognostic factors in lung cancer based on multivariate analysis. Am J Clin Oncol 1993;16:301-9.
5) Fujisawa T, Yamaguchi Y, Saitoh Y, Hiroshima K, Ohwada H. Blood and lymphatic vessel invasion as prognostic factors for patients with primary resected nonsmall cell carcinoma of the lung with intrapulmonary metastases. Cancer 1995; 76:2464-70.
6) Sayar A, Turna A, Solak O, Kiliçgün A, Urer N, Gürses A. Nonanatomic prognostic factors in resected nonsmall cell lung carcinoma: the importance of perineural invasion as a new prognostic marker. Ann Thorac Surg 2004;77:421-5.
7) Naruke T, Tsuchiya R, Kondo H, Asamura H. Prognosis and survival after resection for bronchogenic carcinoma based on the 1997 TNM-staging classification: the Japanese experience. Ann Thorac Surg 2001;71:1759-64.
8) van Rens MT, de la Rivière AB, Elbers HR, van Den Bosch JM. Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA. Chest 2000;117:374-9.
9) Thomas P, Doddoli C, Thirion X, Ghez O, Payan-Defais MJ, Giudicelli R, et al. Stage I non-small cell lung cancer: a pragmatic approach to prognosis after complete resection. Ann Thorac Surg 2002;73:1065-70.
10) Pechet TT, Carr SR, Collins JE, Cohn HE, Farber JL. Arterial invasion predicts early mortality in stage I non-small cell lung cancer. Ann Thorac Surg 2004;78:1748-53.
11) Ogawa J, Tsurumi T, Yamada S, Koide S, Shohtsu A. Blood vessel invasion and expression of sialyl Lewisx and proliferating cell nuclear antigen in stage I non-small cell lung cancer. Relation to postoperative recurrence. Cancer 1994; 73:1177-83.
12) Macchiarini P, Fontanini G, Hardin JM, Pingitore R, Angeletti CA. Most peripheral, node-negative, non-smallcell lung cancers have low proliferative rates and no intratumoral and peritumoral blood and lymphatic vessel invasion. Rationale for treatment with wedge resection alone. J Thorac Cardiovasc Surg 1992;104:892-9.
13) Macchiarini P, Fontanini G, Hardin MJ, Chuanchieh H, Bigini D, Vignati S, et al. Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-smallcell lung cancer. J Thorac Cardiovasc Surg 1993; 106:80-9.
14) Dalquen P, Sauter G, Torhorst J, Schultheiss E, Jordan P, Lehmann S, et al. Nuclear p53 overexpression is an independent prognostic parameter in node negative non-small cell lung carcinoma. J Pathol 1996;178:53-8.
15) Tezel C, Ersev AA, Kiral H, Urek S, Kosar A, Keles M, et al. The impact of immunohistochemical detection of positive lymph nodes in early stage lung cancer. Thorac Cardiovasc Surg 2006;54:124-8.
16) Ichinose Y, Yano T, Asoh H, Yokoyama H, Yoshino I, Katsuda Y. Prognostic factors obtained by a pathologic examination in completely resected non-small cell lung cancer. An analysis in each pathologic stage. J Thorac Cardiovasc Surg 1995;110:601-5.
17) Harpole DH Jr, Herndon JE 2nd, Young WG Jr, Wolfe WG, Sabiston DC Jr. Stage I nonsmall cell lung cancer. A multivariate analysis of treatment methods and patterns of recurrence. Cancer 1995;76:787-96.
18) Gonfiotti A, Crocetti E, Lopes Pegna A, Paci E, Janni A. Prognostic variability in completely resected pN1 nonsmall- cell lung cancer. Asian Cardiovasc Thorac Ann 2008; 16:375-80.
19) Bakir K, Uçak R, Tunçözgür B, Elbeyli L. Prognostic factors and c-erbB-2 expression in non-small-cell lung carcinoma (c-erbB-2 in non-small cell lung carcinoma). Thorac Cardiovasc Surg 2002;50:55-8.
20) Nesbitt JC, Putnam JB Jr, Walsh GL, Roth JA, Mountain CF. Survival in early-stage non-small cell lung cancer. Ann Thorac Surg 1995;60:466-72.
21) Postoperative T1 N0 non-small cell lung cancer. Squamous versus nonsquamous recurrences. The Lung Cancer Study Group. J Thorac Cardiovasc Surg 1987;94:349-54.