FAZLI YANIK, Yekta KARAMUSTAFAOĞLU, Yener YÖRÜK

Akciğerin büyük hücreli nöroendokrin karsinomundaki cerrahi sonuçlarımız

Giriş/Amaç: Akciğerin büyük hücreli nöroendokrin karsinomları (BHNK) yüksek dereceli nadir tümörlerdir ve küçük hücreli akciğer kanserine benzer klinik ve biyolojik özellikler taşırlar. Bu çalışmada histopatolojik tanısı akciğerin BHNK’u olan olgulardaki cerrahi sonuçlarımızı, prognozu ve sağkalımı irdeledik. Materyal-Metod: Haziran 2012-Haziran 2018 tarihleri arasında rezeksiyon yapılan ve patolojik tanıları BHNK olarak raporlanan biri kadın, 11’i erkek, ortalama yaşları 61,4±7,5(48-74 yaş) olan 12 olgu retrospektif olarak değerlendirildi. Prognoz, yaş, cins, sigara içme hikayesi, tümör çapı, tanı tedavi modaliteleri, cerrahi sonuçlar ve sağkalım hastane kayıtlarından analiz edildi. Bulgular: Sekiz olguda tümör sağ hemitoraks yerleşimli iken, dört olguda sol hemitoraks yerleşimliydi. 11 olguda mediastinoskopi ve anatomik akciğer rezeksiyonu ile mediastinal lenf nodu diseksiyonu uygulandı. T1 evreli bir olgu ise bilgisayarlı toraks tomografisinde mediastende patolojik lenf nodu olmadığı için, mediastinoskopi yapılmadan, video yardımlı lobektomi ve mediastinal lenf nodu diseksiyonu uygulandı. Olguların yedisi (%58) takipler sırasında metastaz veya tümör progresyonu nedeniyle kaybedildi. Ortalama tümör çapı, ortalama sağ-kalım süresi, hastalıksız sağ-kalım süresi ve ortalama hastanede kalış süresi sırasıyla; 4,4±2,1 cm (dağılım 1-8 cm), 17,9±19,04 ay (dağılım 2-72 ay), 15,08±19,6 ay ( dağılım 1-72 ay ) ve 6,4±3,6 gün (4-12 gün) olarak hesaplandı. Postoperatif mortalite görülmedi. İki(%16) olguda komplikasyon (atelektazi ve yara yeri enfeksiyonu) görüldü. Sonuç: Tedavi ve sağ-kalım açısından küçük hücreli akciğer kanserine benzer özellikler taşısa da, tedavi stratejisinde tam olarak bir fikir birliğinin sağlanamamıştır. Günümüzde küratif anatomik rezeksiyonlar ve beraberinde eklenecek onkolojik tedaviler uzun dönem sağ-kalım için tek şans gibi gözükmektedir. Ancak bu nadir görülen tümörlerle ilgili daha geniş vaka serilerini içeren çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

akciğer, tümör, nöroendokrin

Surgical outcomes of large cell neuroendocrine carcinoma of the lung

Aim: ‘Large cell neuroendocrine carcinoma of the lung’ (LCNECL) is high-grade rare tumors and has clinical and biological characteristics similar to small cell lung cancer. In this study, we evaluated the surgical results, prognosis and survival of the patients with histopathologically LCNECL.Materials and Methods: Twelve patients, one female and 11 male, with a mean age of 61,4±7,5(48-74 years), who were reported as LCNECL between June 2012 and June 2018 was performed resection, were evaluated retrospectively. Prognosis, age, sex, smoking history, tumor size, diagnostic treatment modalities, surgical outcomes and survival was analyzed from hospital records.Results: While in eight cases the tumor was located in the right hemithorax, in four cases was left hemithorax. Mediastinoscopy and anatomic lung resection with mediastinal lymph node dissection were performed in 11 cases. In one case with T1 stage, video-assisted lobectomy and mediastinal lymph node dissection were performed without mediastinoscopy because there was no pathological lymph node in the mediastinum in chest computerized tomography. Seven patients (58%) died due to tumor progression or metastasis during follow-up. The median tumor size, median survival time, median disease-free survival time and median lenght of hospital time were 4.4±2.1cm (range1-8cm), 17.9±19.04months(range2-72months), 15,08±19.6months(range1-72months) and 6,4±3,6days(4-12days), respectively. There was no postoperative mortality. Two(16%) patients with complications (atelectasis and wound infection) were observed. Conclusion: Although they have similar features with small cell lung cancer in terms of treatment and survival rates, no consensus have been identified in their treatment strategy. Today, curative anatomic resections and accompanying oncological therapies seem to be the only chance for long-term survival. However, there is a need for studies including larger case series about these rare tumors

Keywords:

lung tumor,

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1) Rekhtman N. Neuroendocrine tumors of the lung: an update. Arch Pathol Lab Med 2010; 134:1628-38.
2) Iyoda A, Hiroshima K, Baba M et al. Pulmonary large cell carcinomas with neuroendocrine features are high-grade neuroendocrine tumors. Ann Thorac Surg 2002; 73: 1049-54.
3) Travis WD, Brambilla EW, Burke AP et al. WHO Classification of Tumours of the Lung, Pleura, Thymus, and Heart IARC Press, Lyon 2015.
4) Fernandez FG, Battafarano RJ. Large-cell neuroendocrine carcinoma of the lung. Cancer Control 2006; 13: 270-75.
5) Skuladottir H, Hirsch FR, Hansen HH, Olsen JH. Pulmonary neuroendocrine tumors: incidence and prognosis of histological subtypes: a populationbased study in Denmark. Lung Cancer 2002; 37: 127–35.
6) Shin AR., Shin B.K., Choi J.-A., Oh Y.W., Kim H.K., Kan EY. Large cell neuroendocrine carcinoma of the lung: radiologic and pathologic findings, J Comput Assist Tomogr, 2000; 24: 567-73
7) Fournel L, Falcoz PE, Alifano M, Charpentier MC, Boudaya MS, Magdeleinat P et al. Surgical management of pulmonary large cell neuroendocrine carcinomas: a 10-year experience. European Journal of Cardio-Thoracic Surgery 2013; 43: 111-14
8) Sakurai H, Asamura H. Large-cell neuroendocrine carcinoma of the lung: surgical management. Thoracic Surgery Clinics 2014; 24: 305-11.
9) Fasano M, Corte CMD, Papaccio F et al. Pulmonary large cell neuroendocrine carcinoma From epidemiology to therapy. J Thor Oncol 2015; 10: 1133-41.
10) Rieber J, Schmitt J, Warth A, Muley T, Kappes J, Eichhorn F et al. Outcome and prognostic factors of multimodal therapy for pulmonary large-cell neuroendocrine carcinomas. European Journal of Medical Research 2015; 20: 2-8.
11) Sakai Y, Yamasaki T, Kusakabe Y, Kasai D, Kotani Y et al. Large-cell neuroendocrine carcinoma of lung with epidermal growth factor receptor (EGFR) gene mutation and co-expression of adenocarcinoma markers: a case report and review of the literature. Multidiscip Respir Med 2013; 8: 8-47.
12) Marchetti A, Felicioni L, Pelosi G, Del Grammastro M, Fumagalli C et al. Frequent mutations in the neurotrophic tyrosine receptor kinase gene family in large cell neuroendocrine carcinoma of the lung. Hum Mutat 2008; 29: 609-16.
13) Iyoda A, Travis WD, Sarkaria IS, Jiang SX, Amano H, Sato Y et al. Expression profiling and identification of potential molecular targets for therapy in pulmonary large-cell neuroendocrine carcinoma. Exp Ther Med 2011; 2: 1041-45.
14) Ustaalioglu BBO, Ulas A, Esbah O, Turan N, Bilici A, Demirci U. Large cell neuroendocrine carcinoma: retrospective analysis of 24 cases from four oncology centers in Turkey. Thoracic Cancer 2013; 4: 161–166
15)Iyoda A, Hiroshima K, Moriya Y et al. Postoperative recurrence and the role of adjuvant chemotherapy in patients with pulmonary large-cell neuroendocrine carcinoma. J Thorac Cardiovasc Surg 2009; 138: 446–53.