Araştırma Makalesi
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Tümör Lokalizasyonunun Küçük Hücre Akciğer Kanseri Üzerine Etkileri Ve Prognoz İle İlişkisi

Yıl 2022, Cilt: 6 Sayı: 1, 49 - 57, 27.03.2022
https://doi.org/10.30565/medalanya.969705

Öz

Amaç: Akciğer kanseri, patolojik alt tipler olarak küçük hücreli dışı akciğer kanseri (KHDAK) ve küçük hücreli akciğer kanseri (KHAK) olarak sınıflandırılır. KHAK, önemli ölçüde kısa bir yaşam beklentisi ile ilişkilidir ve tüm akciğer kanserlerinin %10-15'ini oluşturur. Önceki çalışmalar, akciğer kanserinin çoğunlukla üst lobun baskın olduğunu ve sağ akciğerde sola göre daha yaygın olduğunu gösterdi. Bu çalışmanın temel amacı, agresif ve malign KHAK hastalarında tümörün sağ ve sol akciğerdeki lokalizasyonunu anatomik özellikler, demografik özellikler, laboratuvar özellikleri gibi belirleyicilerle karşılaştırarak periferik-merkezi yerleşimlerle ilişkisini de içerecek şekilde analiz etmek ve özellikle de sağkalımı değerlendirmektir.

Yöntem: Bir üçüncü basamak eğitim ve araştırma hastanesinde göğüs hastalıkları kliniğinde 31.03.2014-31.03.2020 tarihleri arasında tanı almış 446 akciğer kanseri hastası tespit edildi. Bunların %20'si (n=90) KHAK tanısı aldı. Doksan hastadan altı tanesi eksik tıbbi kayıtları nedeniyle çalışma dışı bırakıldı ve son olarak KHAK'lı 84 hasta çalışmaya dahil edildi.

Bulgular: 84 hastamızı sağ ve sol akciğerde lokalize KHAK olarak iki ana gruba ayırdık ve tüm verileri analiz ettik. Sol akciğer tümörü grubunun daha yaygın evreli hastalığa sahip olduğunu ve anlamlı derecede yüksek CRP düzeylerine sahip olduğunu bulduk (sırasıyla p=0.027, p=0.045). Sağ ve sol tümör gruplarının demografik özellikleri, tanı yöntemleri, genel sağkalım, tedavi özellikleri, evre özellikleri, anatomik özellikleri gibi verileri analiz ettiğimizde istatistiksel olarak anlamlı bir fark olmadığını gördük. Tüm verilerimizin sağkalım açısından önce tek değişkenli analiz, ardından çok değişkenli analiz ile analiz edilmesi sonucunda; 65 yaş ve üzeri (p=0.014), CRP yüksekliği (p=0.016), santral yerleşimli tümör varlığı (p=0.01), performans düşüklüğü (p<0.0001) ve primer tedaviyi almayan kanser durumu (p=0.001) daha kötü sağkalım ile ilişkilendirildi.

Sonuç: KHAK hastalarının ilk tedavisi hemen başlanmalıdır. Anatomik lokalizasyon olarak tümörün merkezi yerleşiminin daha kötü sağkalım ile ilişkili olabileceğini bulduk. Ayrıca sol akciğer tümörü grubunun daha yaygın evreli hastalığa sahip olduğunu ve CRP düzeylerinin anlamlı derecede yüksek olduğunu bulduk. Altmışbeş yaş ve üstü olmak, yüksek CRP düzeyleri, düşük performans durumuna sahip olmak ve primer kanser tedavisi görmemek, daha kötü sağkalım ile anlamlı olarak ilişkiliydi.

Kaynakça

  • 1. Van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer. Lancet. 2011;378(9804):1741-55. doi: 10.1016/S0140-6736(11)60165-7.
  • 2. Janssen-Heijnen ML, Karim-Kos HE, van der Drift MA, Groen HJ, Ho VK, Koning C, et al. Modest improvements of survival for patients with small cell lung cancer aged 45 to 59 years only, diagnosed in the Netherlands, 1989 to 2008. J Thorac Oncol. 2012;7(1):227-32. doi: 10.1097/JTO.0b013e3182370e4c.
  • 3. Miyauchi E, Motoi N, Ono H, Ninomiya H, Ohyanagi F, Nishio M, et al. Distinct Characteristics of Small Cell Lung Cancer Correlate With Central or Peripheral Origin: Subtyping Based on Location and Expression of Transcription Factor TTF-1. Medicine (Baltimore). 2015;94(51):e2324. doi: 10.1097/MD.0000000000002324.
  • 4. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The Eighth Edition Lung Cancer Stage Classification. Chest. 2017;151(1):193-203. doi: 10.1016/j.chest.2016.10.010.
  • 5. Kalemkerian GP, Schneider BJ. Advances in Small Cell Lung Cancer. Hematol Oncol Clin North Am. 2017;31(1):143-56. doi: 10.1016/j.hoc.2016.08.005.
  • 6. Sahmoun AE, Case LD, Santoro TJ, Schwartz GG. Anatomical distribution of small cell lung cancer: effects of lobe and gender on brain metastasis and survival. Anticancer Res. 2005;25(2A):1101-8. PMID: 15868952.
  • 7. Varlotto JM, Recht A, Flickinger JC, Medford-Davis LN, Dyer AM, DeCamp MM. Lobectomy leads to optimal survival in early-stage small cell lung cancer: a retrospective analysis. J Thorac Cardiovasc Surg. 2011;142(3):538-46. doi: 10.1016/j.jtcvs.2010.11.062.
  • 8. Öz N, Sarper A, Karaveli Ş, Aslaner O, Demircan A, Işın E. A Rare Tracheal Malignant Tumor: Mucoepidermoid Carcinoma (A Case Report). Tüberküloz ve Toraks Dergisi. 2004;52(1):83-5
  • 9. Lally BE, Geiger AM, Urbanic JJ, Butler JM, Wentworth S, Perry MC, et al. Trends in the outcomes for patients with limited stage small cell lung cancer: An analysis of the Surveillance, Epidemiology, and End Results database. Lung Cancer. 2009;64(2):226-31. doi: 10.1016/j.lungcan.2008.08.010.
  • 10. Park HS, Harder EM, Mancini BR, Decker RH. Central versus Peripheral Tumor Location: Influence on Survival, Local Control, and Toxicity Following Stereotactic Body Radiotherapy for Primary Non-Small-Cell Lung Cancer. J Thorac Oncol. 2015;10(5):832-7. doi: 10.1097/JTO.0000000000000484.
  • 11. Kanaji N, Sakai K, Ueda Y, Miyawaki H, Ishii T, Watanabe N, et al. Peripheral-type small cell lung cancer is associated with better survival and higher frequency of interstitial lung disease. Lung Cancer. 2017;108:126-33. doi: 10.1016/j.lungcan.2017.03.013.
  • 12. Li J, Dai CH, Chen P, Wu JN, Bao QL, Qiu H, et al. Survival and prognostic factors in small cell lung cancer. Med Oncol. 2010;27(1):73-81. doi: 10.1007/s12032-009-9174-3.
  • 13. Wang S, Tang J, Sun T, Zheng X, Li J, Sun H, et al. Survival changes in patients with small cell lung cancer and disparities between different sexes, socioeconomic statuses and ages. Sci Rep. 2017;7(1):1339. doi: 10.1038/s41598-017-01571-0.
  • 14. Tas F, Ciftci R, Kilic L, Karabulut S. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett. 2013;6(5):1507-13. doi: 10.3892/ol.2013.1566.
  • 15. Thammakumpee K, Juthong S, Viriyachaiyo V, Rittirak W, Tanomkiat W. Clinical manifestation and survival of patients with small-cell lung cancer. J Med Assoc Thai. 2007;90(7):1303-8. PMID: 17710969.
  • 16. Bremnes RM, Sundstrom S, Aasebø U, Kaasa S, Hatlevoll R, Aamdal S; Norweigian Lung Cancer Study Group. The value of prognostic factors in small cell lung cancer: results from a randomised multicenter study with minimum 5 year follow-up. Lung Cancer. 2003;39(3):303-13. doi: 10.1016/s0169-5002(02)00508-1
  • 17. Wang H, Shan D, Dong Y, Yang X, Zhang L, Yu Z. Correlation analysis of serum cystatin C, uric acid and lactate dehydrogenase levels before chemotherapy on the prognosis of small-cell lung cancer. Oncol Lett. 2021;21(1):73. doi: 10.3892/ol.2020.12334.
  • 18. Mennecier B, Lebitasy MP, Moreau L, Hedelin G, Purohit A, Galichet C, et al. Women and small cell lung cancer: social characteristics, medical history, management and survival: a retrospective study of all the male and female cases diagnosed in Bas-Rhin (Eastern France) between 1981 and 1994. Lung Cancer. 2003;42(2):141-52. doi: 10.1016/s0169-5002(03)00284-8.
  • 19. Neal JW, Gubens MA, Wakelee HA. Current management of small cell lung cancer. Clin Chest Med. 2011;32(4):853-63. doi: 10.1016/j.ccm.2011.07.002.
  • 20. Aupérin A, Arriagada R, Pignon JP, Le Péchoux C, Gregor A, Stephens RJ, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 1999;341(7):476-84. doi: 10.1056/NEJM199908123410703.
  • 21. Hermes A, Gatzemeier U, Waschki B, Reck M. Lactate dehydrogenase as prognostic factor in limited and extensive disease stage small cell lung cancer - a retrospective single institution analysis. Respir Med. 2010;104(12):1937-42. doi: 10.1016/j.rmed.2010.07.013.
  • 22. Hong S, Kang YA, Cho BC, Kim DJ. Elevated serum C-reactive protein as a prognostic marker in small cell lung cancer. Yonsei Med J. 2012;53(1):111-7. doi: 10.3349/ymj.2012.53.1.111.

The Effects Of Tumor Localization On Small Cell Lung Cancer And Its Association With Prognosis

Yıl 2022, Cilt: 6 Sayı: 1, 49 - 57, 27.03.2022
https://doi.org/10.30565/medalanya.969705

Öz

Aim: Lung cancer is classified as non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) as pathological subtypes. SCLC is associated with a significantly short life expectancy, and it constitutes 10-15% of all lung cancers. Previous studies showed that lung cancer is mostly dominated by the upper lobe and is more common in the right lung than in the left. The main aim of this study is to analyze the localization of the tumor in the right and left lung in aggressive and malignant SCLC patients by comparing it with determinants such as anatomical features, demographic features, laboratory features, including the association with peripheral-central localizations, especially overall survival.

Methods: There were four hundred forty-six lung cancer patients diagnosed in a chest diseases clinic in a tertiary training and research hospital between 31.03.2014 and 31.03.2020. Of these, twenty percent (n=90) were diagnosed as SCLC. Among ninety patients, six were excluded from the study due to incomplete medical SCLC records, and finally, eighty-four patients with SCLC were included in the study.

Results: We classified eighty-four patients into two groups as right and left lung localized SCLC and analyzed all the data. We found that the left lung tumor group had the more extensive-stage disease and had significantly high CRP levels (p=0.027, p=0.045, respectively). When we analyzed the data such as demographic characteristics, diagnostic methods, overall survival, treatment characteristics, stage characteristics, anatomical features of the right and left tumor groups, we found that there were no significant differences.We use univariate and then multivariate analysis for survival. We found that being sixty-five years old and over (p=0.014), high CRP levels (p=0.016), having centrally localized tumors (p=0.01), having poor performance status (p<0.0001), and having no treatment for primary cancer (p=0.001) were associated with worse survival.

Conclusion: Primary treatment of SCLC patients should start promptly. We found that the central location of the tumor as anatomical localization may be associated with worse survival. Also, we found that the left lung tumor group had the more extensive-stage disease and had significantly high CRP levels. Being sixty-five years old and over, high CRP levels, having poor performance status, and having no treatment for primary cancer were significantly associated with worse survival. 

Kaynakça

  • 1. Van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer. Lancet. 2011;378(9804):1741-55. doi: 10.1016/S0140-6736(11)60165-7.
  • 2. Janssen-Heijnen ML, Karim-Kos HE, van der Drift MA, Groen HJ, Ho VK, Koning C, et al. Modest improvements of survival for patients with small cell lung cancer aged 45 to 59 years only, diagnosed in the Netherlands, 1989 to 2008. J Thorac Oncol. 2012;7(1):227-32. doi: 10.1097/JTO.0b013e3182370e4c.
  • 3. Miyauchi E, Motoi N, Ono H, Ninomiya H, Ohyanagi F, Nishio M, et al. Distinct Characteristics of Small Cell Lung Cancer Correlate With Central or Peripheral Origin: Subtyping Based on Location and Expression of Transcription Factor TTF-1. Medicine (Baltimore). 2015;94(51):e2324. doi: 10.1097/MD.0000000000002324.
  • 4. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The Eighth Edition Lung Cancer Stage Classification. Chest. 2017;151(1):193-203. doi: 10.1016/j.chest.2016.10.010.
  • 5. Kalemkerian GP, Schneider BJ. Advances in Small Cell Lung Cancer. Hematol Oncol Clin North Am. 2017;31(1):143-56. doi: 10.1016/j.hoc.2016.08.005.
  • 6. Sahmoun AE, Case LD, Santoro TJ, Schwartz GG. Anatomical distribution of small cell lung cancer: effects of lobe and gender on brain metastasis and survival. Anticancer Res. 2005;25(2A):1101-8. PMID: 15868952.
  • 7. Varlotto JM, Recht A, Flickinger JC, Medford-Davis LN, Dyer AM, DeCamp MM. Lobectomy leads to optimal survival in early-stage small cell lung cancer: a retrospective analysis. J Thorac Cardiovasc Surg. 2011;142(3):538-46. doi: 10.1016/j.jtcvs.2010.11.062.
  • 8. Öz N, Sarper A, Karaveli Ş, Aslaner O, Demircan A, Işın E. A Rare Tracheal Malignant Tumor: Mucoepidermoid Carcinoma (A Case Report). Tüberküloz ve Toraks Dergisi. 2004;52(1):83-5
  • 9. Lally BE, Geiger AM, Urbanic JJ, Butler JM, Wentworth S, Perry MC, et al. Trends in the outcomes for patients with limited stage small cell lung cancer: An analysis of the Surveillance, Epidemiology, and End Results database. Lung Cancer. 2009;64(2):226-31. doi: 10.1016/j.lungcan.2008.08.010.
  • 10. Park HS, Harder EM, Mancini BR, Decker RH. Central versus Peripheral Tumor Location: Influence on Survival, Local Control, and Toxicity Following Stereotactic Body Radiotherapy for Primary Non-Small-Cell Lung Cancer. J Thorac Oncol. 2015;10(5):832-7. doi: 10.1097/JTO.0000000000000484.
  • 11. Kanaji N, Sakai K, Ueda Y, Miyawaki H, Ishii T, Watanabe N, et al. Peripheral-type small cell lung cancer is associated with better survival and higher frequency of interstitial lung disease. Lung Cancer. 2017;108:126-33. doi: 10.1016/j.lungcan.2017.03.013.
  • 12. Li J, Dai CH, Chen P, Wu JN, Bao QL, Qiu H, et al. Survival and prognostic factors in small cell lung cancer. Med Oncol. 2010;27(1):73-81. doi: 10.1007/s12032-009-9174-3.
  • 13. Wang S, Tang J, Sun T, Zheng X, Li J, Sun H, et al. Survival changes in patients with small cell lung cancer and disparities between different sexes, socioeconomic statuses and ages. Sci Rep. 2017;7(1):1339. doi: 10.1038/s41598-017-01571-0.
  • 14. Tas F, Ciftci R, Kilic L, Karabulut S. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett. 2013;6(5):1507-13. doi: 10.3892/ol.2013.1566.
  • 15. Thammakumpee K, Juthong S, Viriyachaiyo V, Rittirak W, Tanomkiat W. Clinical manifestation and survival of patients with small-cell lung cancer. J Med Assoc Thai. 2007;90(7):1303-8. PMID: 17710969.
  • 16. Bremnes RM, Sundstrom S, Aasebø U, Kaasa S, Hatlevoll R, Aamdal S; Norweigian Lung Cancer Study Group. The value of prognostic factors in small cell lung cancer: results from a randomised multicenter study with minimum 5 year follow-up. Lung Cancer. 2003;39(3):303-13. doi: 10.1016/s0169-5002(02)00508-1
  • 17. Wang H, Shan D, Dong Y, Yang X, Zhang L, Yu Z. Correlation analysis of serum cystatin C, uric acid and lactate dehydrogenase levels before chemotherapy on the prognosis of small-cell lung cancer. Oncol Lett. 2021;21(1):73. doi: 10.3892/ol.2020.12334.
  • 18. Mennecier B, Lebitasy MP, Moreau L, Hedelin G, Purohit A, Galichet C, et al. Women and small cell lung cancer: social characteristics, medical history, management and survival: a retrospective study of all the male and female cases diagnosed in Bas-Rhin (Eastern France) between 1981 and 1994. Lung Cancer. 2003;42(2):141-52. doi: 10.1016/s0169-5002(03)00284-8.
  • 19. Neal JW, Gubens MA, Wakelee HA. Current management of small cell lung cancer. Clin Chest Med. 2011;32(4):853-63. doi: 10.1016/j.ccm.2011.07.002.
  • 20. Aupérin A, Arriagada R, Pignon JP, Le Péchoux C, Gregor A, Stephens RJ, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 1999;341(7):476-84. doi: 10.1056/NEJM199908123410703.
  • 21. Hermes A, Gatzemeier U, Waschki B, Reck M. Lactate dehydrogenase as prognostic factor in limited and extensive disease stage small cell lung cancer - a retrospective single institution analysis. Respir Med. 2010;104(12):1937-42. doi: 10.1016/j.rmed.2010.07.013.
  • 22. Hong S, Kang YA, Cho BC, Kim DJ. Elevated serum C-reactive protein as a prognostic marker in small cell lung cancer. Yonsei Med J. 2012;53(1):111-7. doi: 10.3349/ymj.2012.53.1.111.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Sertan Bulut 0000-0003-1267-3440

Deniz Çelik 0000-0003-4634-205X

Yayımlanma Tarihi 27 Mart 2022
Gönderilme Tarihi 11 Temmuz 2021
Kabul Tarihi 26 Ekim 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 6 Sayı: 1

Kaynak Göster

Vancouver Bulut S, Çelik D. The Effects Of Tumor Localization On Small Cell Lung Cancer And Its Association With Prognosis. Acta Med. Alanya. 2022;6(1):49-57.

9705 

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