Küçük hücreli dışı akciğer kanserlerinde morfolojik prognostik faktörlerin retrospektif değerlendirilmesi
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Date
2019
Authors
Hasdemir, Seçil
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Akciğer kanseri dünya genelinde insidansı ve mortalitesi en yüksek olan kanser türüdür. Akciğer kanseri patogenezinde birçok sürücü mutasyon tanımlanmış ve hedefe yönelik tedavide önemli gelişmeler elde edilmiştir. Ancak hala akciğer kanserlerinin morfolojik prognostik faktörlerinin belirlenmesi ile ilgili çalışmalar devam etmektedir. Bu çalışmanın amacı küçük hücreli dışı akciğer karsinomunda izlenen başta tümör tomurcuklanması olmak üzere çeşitli morfolojik bulguların prognoz ile ilişkisini araştırmaktır. Çalışmamıza Bursa Uludağ Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı'nda 2014-2016 yılları arasında rezeksiyon materyallerinden akciğer adenokarsinom, skuamöz hücreli karsinom, adenoskuamöz karsinom ve büyük hücreli nöroendokrin karsinom tanısı alan 155 olgu dahil edildi. Olguların klinikopatolojik verileri elektronik ortamdaki hastane dosyalarından elde edildi. Olgulara ait tüm preparatlar arşivden çıkarılarak tümör tomurcuklanması, histolojik tip, histolojik alt tip, nekroz, mitoz, stromal yanıt, stromal iltihabi yanıt, lenfovasküler invazyon ve plevral invazyon varlığı açısından değerlendirildi. Elde edilen verilerin uzak metastaz ve sağkalım ilişkisi istatistiksel olarak araştırıldı. Cox regresyon analizine göre yaş (p=0,010), plevral invazyon (p=0,028), lenfovasküler invazyon (p=0,003), nekroz (p=0,010) ve stromal iltihabi yanıt (p=0,008) genel sağkalım açısından bağımsız prognostik faktörler olarak bulundu. Adenokarsinomlarda tümör tomurcuklanması ile patolojik evre (p=0,006), çap (p=0,022), nekroz varlığı (p=0,002), mitoz oranı (p=0,022) ve stromal iltihabi yanıt (p=0,035) arasında istatistiksel olarak anlamlı ilişki bulundu. Adenokarsinom alt tipleri ile tümör tomurcuklanması arasında istatistiksel olarak anlamlı sonuç bulunamadı (p=0,055), ancak solid adenokarsinomlarda tümör tomurcuklanması daha iii yüksek oranda izlendi. Skuamöz hücreli karsinom olgularında morfolojik prognostik faktörler ile tümör tomurcuklanması arasında istatistiksel olarak anlamlı ilişki bulunmadı. Sonuç olarak rutin patoloji pratiğinde adenokarsinom ve skuamöz hücreli karsinom raporlarında tümör tomurcuklanmasının diğer prognostik faktörlerle birlikte yer alması gerektiğini düşünmekteyiz.
Lung cancer has the highest incidence and mortality rates worldwide. A wide range of driver mutations have been identified in the pathogenesis of lung cancer and significant advances have been achieved regarding targeted therapy. However, studies are still conducted to determine the morphological prognostic factors. The aim of this study was to investigate the association of various morphological findings, particularly tumor budding, with prognosis in non-small cell lung carcinoma. Our study included 155 patients with adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma and large cell neuroendocrine carcinoma diagnosed from lung resection materials, between 2014 and 2016 in Bursa Uludag University Faculty of Medicine Pathology Department. Clinicopathological data of the cases were acquired from the electronic hospital files. The slides of the cases were obtained from the pathology archives and tumor budding, histologic type, histologic subtype, necrosis, mitosis, stromal response, stromal inflammatory response, lymphovascular invasion and pleural invasion were evaluated. The relationship between the data obtained and distant metastasis and survival rates were statistically analyzed. According to Cox regression analysis, age (p=0,010), pleural invasion (p=0,028), lymphovascular invasion (p=0,003), necrosis (p=0,010) and stromal inflammatory response (p=0,008) were found to be independent prognostic factors for overall survival. There was a statistically significant v correlation between tumor budding and pathologic stage (p=0,006), diameter (p=0,022), presence of necrosis (p=0,002), mitosis (p=0,022) and stromal inflammatory response (p=0,035) in adenocarcinoma. There was no evident difference between adenocarcinoma subtypes and tumor budding (p=0.055), but tumor budding was observed at a higher rate in solid adenocarcinoma. Statistically significant relationship between morphologic prognostic factors and tumor budding in squamous cell carcinoma were not found. In conclusion, reports of adenocarcinoma and squamous cell carcinoma in routine pathology practices should include tumor budding along with the other prognostic factors.
Lung cancer has the highest incidence and mortality rates worldwide. A wide range of driver mutations have been identified in the pathogenesis of lung cancer and significant advances have been achieved regarding targeted therapy. However, studies are still conducted to determine the morphological prognostic factors. The aim of this study was to investigate the association of various morphological findings, particularly tumor budding, with prognosis in non-small cell lung carcinoma. Our study included 155 patients with adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma and large cell neuroendocrine carcinoma diagnosed from lung resection materials, between 2014 and 2016 in Bursa Uludag University Faculty of Medicine Pathology Department. Clinicopathological data of the cases were acquired from the electronic hospital files. The slides of the cases were obtained from the pathology archives and tumor budding, histologic type, histologic subtype, necrosis, mitosis, stromal response, stromal inflammatory response, lymphovascular invasion and pleural invasion were evaluated. The relationship between the data obtained and distant metastasis and survival rates were statistically analyzed. According to Cox regression analysis, age (p=0,010), pleural invasion (p=0,028), lymphovascular invasion (p=0,003), necrosis (p=0,010) and stromal inflammatory response (p=0,008) were found to be independent prognostic factors for overall survival. There was a statistically significant v correlation between tumor budding and pathologic stage (p=0,006), diameter (p=0,022), presence of necrosis (p=0,002), mitosis (p=0,022) and stromal inflammatory response (p=0,035) in adenocarcinoma. There was no evident difference between adenocarcinoma subtypes and tumor budding (p=0.055), but tumor budding was observed at a higher rate in solid adenocarcinoma. Statistically significant relationship between morphologic prognostic factors and tumor budding in squamous cell carcinoma were not found. In conclusion, reports of adenocarcinoma and squamous cell carcinoma in routine pathology practices should include tumor budding along with the other prognostic factors.
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Keywords
Akciğer, Küçük hücreli dışı, Prognoz, Tümör tomurcuklanması, Sağkalım, Lung, Prognosis, Survival, Tumor budding, Non-small cell lung cancer
Citation
Hasdemir, S. (2019). Küçük hücreli dışı akciğer kanserlerinde morfolojik prognostik faktörlerin retrospektif değerlendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.