Öz
Aim. The purpose of this study is to examine the prognostic factors effecting the survival of stage IV non-small cell lung cancer patients. Method. Demographic, clinical and histopathologic data from 2006 to 2011 were collected from non-small cell lung cancer patients who were treated in our clinic. With the permission of the patients who didn’t attend to routine follow-ups, their names were searched in identification interrogation system in order to use their identity information in survival analysis. In order to analyze frequency distributions, Mann-Whitney U test and KaplanMeier survival analysis were used. Results. A hundred (88%) male, 13 (12%) female of total 113 patients data were analyzed. The mean age was 62 (37-82). 90 (80%) of the patients were smokers, family history existed in 27 (24%) of the patients, 40 (35%) of patients were with comorbidities. According to the histopathological aspect; 24 (21%) patients were epidermoid, 30 (27%) adenocarsinoma, 3 (2%) neuroendocrine, 56 (50%) patients had unspecified non-small cell lung carcinoma. The most common Eastern Cooperative Oncology Group Perfromance Status was ECOG 1. Frequent sites of metastasis: 40 (35%) brain, 36 (32%) bone, 24 (21%) liver, 20 (18%) opposite lung. Chemotherapy was given to 83 (73%) patient whereas supportive therapy was given to 30 (27%) of the patients. Pain-killers were used in 84 (74%) patients, palliative radiotherapy was apllied to 69 (61%). Median follow-up was 8 months (1-47), median survival was 8 months. One-year overall survival was 35 Eastern Cooperative Oncology Group Perfromance Status (p<0.001), and chemotherapy (p<0.001), and usage of cisplatin (p<0.001) and docetaxel (p=0.043) during the treatment, increased levels of lactic dehydrogenase (p=0.007) were the prognostic factors effecting the survival. Chemotherapy (p<0.001) and high lactic dehydrogenase levels (p=0.004) were the independent prognostic factors. Conclusion. In stage IV non-small cell lung cancer the most important prognostic factors effecting the survival are chemotherapy and elevated lactic dehydrogenase levels.
Anahtar Kelimeler
Kaynakça
- Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. 4. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90.
- Silvestri GA, Tanoue LT, Margolis ML, Barker J, Detterbeck F; American College of Chest Physicians. The noninvasive staging of non-small cell lung cancer: the guidelines. Chest 2003; 123: 147S-156S.
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225-49.
- Fossella F, Pereira JR, von Pawel J, Pluzanska A, Gorbounova V, Kaukel E, Mattson KV, Ramlau R, Szczesna A, Fidias P, Millward M, Belani CP. Randomized, multinational, phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 study group. J Clin Oncol 2003; 21: 3016-24.
- Wigren T. Confirmation of a prognostic index for patients with inoperable nonsmall cell lung cancer. Radiother Oncol 1997; 44: 9-15.
- Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-55.
- Akkoçlu A, Savaş İ, Göksel T, Yılmaz U, Akciğer Kanseri Tanı ve Tedavi Rehberi. , Göksel T, Özlü T (eds), In: Akciğer ve Plevra Maliğniteleri Tedavisi Türk Toraks Derneği Okulu Kitabı, Sentez Matbaacılık, Ankara, 2008; 9-11. Socinski MA, Morris DE, Masters GA, Lilenbaum R; American College of Chest Physicians. Chemotherapeutic management of stage IV non-small cell lung cancer. Chest 2003; 123: 226-243.
- Okamoto T, Maruyama R, Shoji F, Asoh H, Ikeda J, Miyamoto T, Nakamura T, Miyake T, Ichinose Y. Long-term survivors in stage IV non-small cell lung cancer. Lung Cancer 2005; 47: 85-91
- Sugiura S, Ando Y, Minami H, Ando M, Sakai S, Shimokata K. Prognostic value of pleural effusion in patients with non-small cell lung cancer. Clin Cancer Res 1997; 3: 47-50.
- Hayes DN, Monti S, Parmigiani G, Gilks CB, Naoki K, Bhattacharjee A, Socinski MA, Perou C, Meyerson M. Gene expression profiling reveals reproducible human lung adenocarcinoma subtypes in multiple independent patient cohorts. J Clin Oncol 2006; 24: 5079-90.
- Gore E, Movsas B, Santana-Davila R, Langer C. Evaluation and management of elderly patients with lung cancer. Semin Radiat Oncol 2012; 22: 304-10.
- Charloux A, Hedelin G, Dietemann A, Ifoundza T, Roeslin N, Pauli G, Quoix E. Prognostic value of histology in patients with non-small cell lung cancer. Lung Cancer 1997; 17: 123-34.
- Wigren T, Oksanen H, Kellokumpu-Lehtinen P. A practical prognostic index for inoperable non-small-cell lung cancer. J Cancer Res Clin Oncol 1997; 123: 2596
- Shinkai T, Eguchi K, Sasaki Y, Tamura T, Ohe Y, Kojima A, Oshita F, Miya T, Okamoto H, Iemura K, et al. A prognostic-factor risk index in advanced nonsmall-cell lung cancer treated with cisplatin-containing combination chemotherapy. Cancer Chemother Pharmacol 1992; 30: 1-6.
- Paesmans M, Sculier JP, Libert P, Bureau G, Dabouis G, Thiriaux J, Michel J, Van Cutsem O, Sergysels R, Mommen P, et al. Prognostic factors for survival in advanced non-small-cell lung cancer: univariate and multivariate analyses including recursive partitioning and amalgamation algorithms in 1,052 patients. The European Lung Cancer Working Party. J Clin Oncol 1995; 13: 1221-30. Scott HR, McMillan DC, Crilly A, McArdle CS, Milroy R. The relationship between weight loss and interleukin 6 in non-small-cell lung cancer. Br J Cancer 1996; 73: 1560-2.
- Sánchez-Lara K, Turcott JG, Juárez E, Guevara P, Nşñez-Valencia C, OñateOcaña LF, Flores D, Arrieta O. Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study. Nutr Cancer 2012; 64: 526-34.
- Shintani Y, Ikeda N, Matsumoto T, Kadota Y, Okumura M, Ohno Y, Ohta M. Nutritional status of patients undergoing chemoradiotherapy for lung cancer. Asian Cardiovasc Thorac Ann 2012; 20: 172-6.
- Cağlayan B, Fidan A, Salepçi B, Kiral N, Torun E, Salepçi T, Mayadağli A. Effects of prognostic factors and treatment on survival in advanced non-small cell lung cancer. Tuberk Toraks 2004; 52: 323-32.
- Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S, Klein P, Brunner TB, Papadopoulos T, Hohenberger W, Hahn EG, Wiest GH. Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. Anticancer Res 2006; 26: 4825-32.
- Xu CH, Yu LK, Zhang Y, Xie HY, Hao KK, Hu W, Xia N, Zhan P. Analysis of prognostic factors of non-small cell lung cancer in patients under 40 years of age. Zhonghua Zhong Liu Za Zhi 2012; 34: 703-5.
- Azzoli CG, Baker S Jr, Temin S, Pao W, Aliff T, Brahmer J, Johnson DH, Laskin JL, Masters G, Milton D, Nordquist L, Pfister DG, Piantadosi S, Schiller JH, Smith R, Smith TJ, Strawn JR, Trent D, Giaccone G; American Society of Clinical Oncology. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol 2009; 27: 6251-66.
- D'Addario G, Felip E; ESMO Guidelines Working Group. Non-small-cell lung cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20: 68-70.
- Custodio A, de Castro J. Strategies for maintenance therapy in advanced nonsmall cell lung cancer: current status, unanswered questions and future directions. Crit Rev Oncol Hematol 2012; 82: 338-60.
Öz
Amaç. Bu çalışmada evre IV küçük hücreli dışı akciğer kanserli hastalarda tedavi öncesi
prognostik faktörlerin sağkalım üzerine etkilerinin incelenmesi amaçlandı. Yöntem: Bu çalışma
2006-2011 tarihleri arasında merkezimize tedavi edilen evre IV küçük hücreli dışı akciğer kanserli
113 hastanın dosyalarının retrospektif incelenmesi ile yapıldı. Hastalara ait demografik, klinik ve
histopatolojik veriler hasta dosya ve hastane kayıtları incelenerek elde edildi. Kontrole gelmemiş
hastalar sağkalım analizi için, izin alınarak kimlik sorgulama sisteminde sorgulandı. Analiz için
sıklık testleri, Mann-Whitney U testi ve Kaplan-Meier analizi kullanıldı. Bulgular. Yüzü (%88)
erkek, 13'ü (%12) kadın toplam 113 hastanın verisi analiz edildi. Ortanca yaş 62 (37-82) idi.
Sigara kullanımı 90 (%80) hastada, aile hikayesi 27 (%24) hastada, komorbidite 40 (%35) hastada
mevcuttu. Histopatolojik alt tip olarak 24 (%21) hasta epidermoid, 30 (%27) hasta adenokarsinom,
3 (%2) hasta nöroendokrin alt tipine sahipti. Ellialtı (%50) hastanın ise histopatolojik alt tipi
belirlenememişti. En sık rastalanan Eastern Cooperative Oncology Group Perfromance Statusu
ECOG 1 idi. En sık metastaz yerleri beyin (%35), kemik (%32), karaciğer (%21) ve karşı akciğer
(%18) idi. Hastaların 83'üne (%73) kemoterapi uygulanırken 30'una (%27) destek tedavisi verildi.
Analjezik kullanımı 84 (%74) hastada var iken palyatif radyoterapi 69 (%61) hastaya uygulandı.
Ortanca takip 8 ay (1-47), ortanca sağkalım 8 ay idi. Bir yıllık genel sağkalım %35 olarak tespit
edildi. Eastern Cooperative Oncology Group Perfromance Statusu (p < 0,001), kemoterapi
uygulaması (p < 0,001), tedavide cisplatin (p < 0,001) ve docetaxel (p=0,043) kullanımı, laktik
dehidrogenaz yüksekliği (p=0,007) sağkalımı belirleyen prognostik faktörlerdi. Kemoterapi
uygulaması (p < 0,001) ve laktik dehidrogenaz yüksekliği (p=0,004) ise bağımsız prognostik
faktörlerdi. Sonuç. Evre IV küçük hücreli dışı akciğer kanserinde sağkalımı etkileyen en önemli
prognostik faktörler hastaya kemoterapi uygulanması ve laktik dehidrogenaz yüksekliği olarak
tespit edildi.
Anahtar Kelimeler
Evre IV küçük hücreli dışı akciğer kanseri sağkalım prognosis
Kaynakça
- Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. 4. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90.
- Silvestri GA, Tanoue LT, Margolis ML, Barker J, Detterbeck F; American College of Chest Physicians. The noninvasive staging of non-small cell lung cancer: the guidelines. Chest 2003; 123: 147S-156S.
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225-49.
- Fossella F, Pereira JR, von Pawel J, Pluzanska A, Gorbounova V, Kaukel E, Mattson KV, Ramlau R, Szczesna A, Fidias P, Millward M, Belani CP. Randomized, multinational, phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 study group. J Clin Oncol 2003; 21: 3016-24.
- Wigren T. Confirmation of a prognostic index for patients with inoperable nonsmall cell lung cancer. Radiother Oncol 1997; 44: 9-15.
- Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-55.
- Akkoçlu A, Savaş İ, Göksel T, Yılmaz U, Akciğer Kanseri Tanı ve Tedavi Rehberi. , Göksel T, Özlü T (eds), In: Akciğer ve Plevra Maliğniteleri Tedavisi Türk Toraks Derneği Okulu Kitabı, Sentez Matbaacılık, Ankara, 2008; 9-11. Socinski MA, Morris DE, Masters GA, Lilenbaum R; American College of Chest Physicians. Chemotherapeutic management of stage IV non-small cell lung cancer. Chest 2003; 123: 226-243.
- Okamoto T, Maruyama R, Shoji F, Asoh H, Ikeda J, Miyamoto T, Nakamura T, Miyake T, Ichinose Y. Long-term survivors in stage IV non-small cell lung cancer. Lung Cancer 2005; 47: 85-91
- Sugiura S, Ando Y, Minami H, Ando M, Sakai S, Shimokata K. Prognostic value of pleural effusion in patients with non-small cell lung cancer. Clin Cancer Res 1997; 3: 47-50.
- Hayes DN, Monti S, Parmigiani G, Gilks CB, Naoki K, Bhattacharjee A, Socinski MA, Perou C, Meyerson M. Gene expression profiling reveals reproducible human lung adenocarcinoma subtypes in multiple independent patient cohorts. J Clin Oncol 2006; 24: 5079-90.
- Gore E, Movsas B, Santana-Davila R, Langer C. Evaluation and management of elderly patients with lung cancer. Semin Radiat Oncol 2012; 22: 304-10.
- Charloux A, Hedelin G, Dietemann A, Ifoundza T, Roeslin N, Pauli G, Quoix E. Prognostic value of histology in patients with non-small cell lung cancer. Lung Cancer 1997; 17: 123-34.
- Wigren T, Oksanen H, Kellokumpu-Lehtinen P. A practical prognostic index for inoperable non-small-cell lung cancer. J Cancer Res Clin Oncol 1997; 123: 2596
- Shinkai T, Eguchi K, Sasaki Y, Tamura T, Ohe Y, Kojima A, Oshita F, Miya T, Okamoto H, Iemura K, et al. A prognostic-factor risk index in advanced nonsmall-cell lung cancer treated with cisplatin-containing combination chemotherapy. Cancer Chemother Pharmacol 1992; 30: 1-6.
- Paesmans M, Sculier JP, Libert P, Bureau G, Dabouis G, Thiriaux J, Michel J, Van Cutsem O, Sergysels R, Mommen P, et al. Prognostic factors for survival in advanced non-small-cell lung cancer: univariate and multivariate analyses including recursive partitioning and amalgamation algorithms in 1,052 patients. The European Lung Cancer Working Party. J Clin Oncol 1995; 13: 1221-30. Scott HR, McMillan DC, Crilly A, McArdle CS, Milroy R. The relationship between weight loss and interleukin 6 in non-small-cell lung cancer. Br J Cancer 1996; 73: 1560-2.
- Sánchez-Lara K, Turcott JG, Juárez E, Guevara P, Nşñez-Valencia C, OñateOcaña LF, Flores D, Arrieta O. Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study. Nutr Cancer 2012; 64: 526-34.
- Shintani Y, Ikeda N, Matsumoto T, Kadota Y, Okumura M, Ohno Y, Ohta M. Nutritional status of patients undergoing chemoradiotherapy for lung cancer. Asian Cardiovasc Thorac Ann 2012; 20: 172-6.
- Cağlayan B, Fidan A, Salepçi B, Kiral N, Torun E, Salepçi T, Mayadağli A. Effects of prognostic factors and treatment on survival in advanced non-small cell lung cancer. Tuberk Toraks 2004; 52: 323-32.
- Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S, Klein P, Brunner TB, Papadopoulos T, Hohenberger W, Hahn EG, Wiest GH. Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. Anticancer Res 2006; 26: 4825-32.
- Xu CH, Yu LK, Zhang Y, Xie HY, Hao KK, Hu W, Xia N, Zhan P. Analysis of prognostic factors of non-small cell lung cancer in patients under 40 years of age. Zhonghua Zhong Liu Za Zhi 2012; 34: 703-5.
- Azzoli CG, Baker S Jr, Temin S, Pao W, Aliff T, Brahmer J, Johnson DH, Laskin JL, Masters G, Milton D, Nordquist L, Pfister DG, Piantadosi S, Schiller JH, Smith R, Smith TJ, Strawn JR, Trent D, Giaccone G; American Society of Clinical Oncology. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol 2009; 27: 6251-66.
- D'Addario G, Felip E; ESMO Guidelines Working Group. Non-small-cell lung cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20: 68-70.
- Custodio A, de Castro J. Strategies for maintenance therapy in advanced nonsmall cell lung cancer: current status, unanswered questions and future directions. Crit Rev Oncol Hematol 2012; 82: 338-60.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Şubat 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 3 |