Akciğer kanserli olgularda tromboz ve profilaktik varfarin tedavisinin etkinliği =Thrombosis in patients with lung cancer the effectiveness of warfarin prophylaxis
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2006
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info:eu-repo/semantics/openAccess
Özet
ÖZET Akciğer kanseri Dünya'da olduğu gibi Türkiye'de de büyük bir sağlık sorunu olmaya devam etmektedir. Akciğer kanseri tanı ve tedavisindeki tüm gelişmelere rağmen, 5 yıllık sağkalımda çok fazla artış saptanmamıştır. Bu çalışmada düşük doz varfarin profilaksisinin akciğer kanserinde yaşam süresine katkısını ortaya çıkarmayı amaçladık. Eylül 2004-Ekim 2005 tarihleri arasında Trakya Üniversitesi Göğüs Hastalıklarına Kliniğine başvuran, 91 akciğer kanseri hastası çalışmaya alındı. Olguların %93.4 erkek, %6.6 kadındı. Hastaların 20'si küçük hücreli akciğer kanseri iken, 63'ü küçük hücreli dışı akciğer kanseri, 8'nin hücre tipi belli değildi. Varfarin profilaksisi alan grupta 44, almayan grupta 47 hasta vardı. Her iki grup arasında yaş ve cins dağılımı arasında fark yoktu. Varfarin profilaksisi alan grupta evre IIIB ve IV olan hastaların sayısı 38, almayan grupta 41 idi. Evre IIIB ve IV hastalarda ortalama yaşam süreleri karşılaştırıldığında tedaviye başlangıcından itibaren ortalama yaşam süresi varfarin alan grupta 375.59+34.01, medyan yaşam süresi 358, %95 GA (226.90-489.10) gündü. Almayan grupta ise ortalama yaşam süresi 280.30+34.01, medyan yaşam süresi 236, %95 GA (187.07-284.93) gündü. Trombozu olan 28 hastanın ortalama yaşam süresi daha kısaydı. Ayrıca çalışma boyunca 7 hastada tromboz saptandı. Yaşayan hastalarda d-dimer ve fibrinojen düzeyi ölen hastalara oranlara ortalama değerleri daha düşük olarak saptandı. D-dimer ve fibrinojen düzeyi tam ve parsiyel yanıtta progresif hastalığa göre anlamlı olarak düşük saptandı. Çalışmada araştırılan protrombin fragman 1.2, Faktör VIII, Aktive protein C rezistansı, tanı anında trombozu olan hastalar ile tromboz saptanmayan hastalar karşılaştırıldığında istatistiksel fark saptanmadı. Protrombin 1.2 ile yaşam kalite skoru arasında pozitif korelasyon saptandı. Protrombin 1.2'nin yaşam süresine etkisinin yanı sıra yaşam kalitesine olan etkisini de çalışmamızda saptadık. Çalışmanın sonucunda akciğer kanserinde varfarinin yaşam süresine olumlu katkısını gösterdik. Ancak varfarinin dozu, kullanma süresinin daha net ortaya konması ve diğer antikoagülan ilaçlarla karşılaştırılarak, kanserin hangi evresinde daha iyi yanıt verdiği görmek için daha geniş serilere ihtiyaç vardır. Anahtar Kelimeler: Akciğer Kanseri, varfarin, tromboz, yaşam süresi
THROMBOSIS IN PATIENTS WITH LUNG CANCER AND THE EFFECTIVENESS OF WARFARIN PROPHYLAXIS SUMMARY Lung cancer remains to be a major health problem in Turkey as well as throughout the world. In spite of developments in the diagnosis and treatment of lung cancer, 5-year survival rate stay unchanged and very poor. The aim of this study was to investigate the effectiveness of low dose warfarin prophylaxis in the survival rate of patients with lung cancer. 91 lung cancer patients who applied Trakya University Chest Department between September 2004-October 2005 were enrolled in to the study. 93.4% patients were male; 6.6% patients were female. 63 patients were non-small lung cancer, 20 patients were small cell lung cancer and 8 patients had no type of lung cancer. 44 patients were administered warfarin prophylaxis and 47 had not been given warfarin therapy. There was no significant difference in age and gender between two groups. In warfarin group 38 patients had stage IIIB and IV, in the other group 41 patients had stage IIIB and IV. When survival time were compared between two groups, average survival time for patients who had stage 3B-4 in warfarin group was 375.59 +34.01 days, median survival time was 358 (95% Confidence Interval 226.90- 489.10) and average survival time was 280.20+34.01 days and median survival time was 236 (95% Confidence Interval 187.07-284.93) in patients who were not given warfarin. Average survival time was shorter in 28 patients who had thrombosis. During the study period thrombosis was found in 7 patients. D-dimer and fibrinojen average levels were lower in live patients when comparing with exitus patients. D-dimer and fibrinojen level were found lower in patients who had complete and partial response, comparing with progressive disease. No statistically significant difference was found in prothrombin fragmant 1.2, Factor VIII, Active protein C resistance levels between patients with and without. Positive correlation was found between prothrombin fragmant 1.2 and quality of life score. In this study the effectiveness of prothrombin fragmant 1.2 on quality of life and survival time was found. In conclusion; warfarin prophylaxis is effective in improving survival time in lung cancer patients. But further larger studies are necessary for determining the answers to the questions such as warfarin dosage, warfarin usage time, comparative treatment with warfarin and other anticoagulants, and in which stage good response can be seen. Key words: Lung cancer, warfarin, thrombosis, survival time
THROMBOSIS IN PATIENTS WITH LUNG CANCER AND THE EFFECTIVENESS OF WARFARIN PROPHYLAXIS SUMMARY Lung cancer remains to be a major health problem in Turkey as well as throughout the world. In spite of developments in the diagnosis and treatment of lung cancer, 5-year survival rate stay unchanged and very poor. The aim of this study was to investigate the effectiveness of low dose warfarin prophylaxis in the survival rate of patients with lung cancer. 91 lung cancer patients who applied Trakya University Chest Department between September 2004-October 2005 were enrolled in to the study. 93.4% patients were male; 6.6% patients were female. 63 patients were non-small lung cancer, 20 patients were small cell lung cancer and 8 patients had no type of lung cancer. 44 patients were administered warfarin prophylaxis and 47 had not been given warfarin therapy. There was no significant difference in age and gender between two groups. In warfarin group 38 patients had stage IIIB and IV, in the other group 41 patients had stage IIIB and IV. When survival time were compared between two groups, average survival time for patients who had stage 3B-4 in warfarin group was 375.59 +34.01 days, median survival time was 358 (95% Confidence Interval 226.90- 489.10) and average survival time was 280.20+34.01 days and median survival time was 236 (95% Confidence Interval 187.07-284.93) in patients who were not given warfarin. Average survival time was shorter in 28 patients who had thrombosis. During the study period thrombosis was found in 7 patients. D-dimer and fibrinojen average levels were lower in live patients when comparing with exitus patients. D-dimer and fibrinojen level were found lower in patients who had complete and partial response, comparing with progressive disease. No statistically significant difference was found in prothrombin fragmant 1.2, Factor VIII, Active protein C resistance levels between patients with and without. Positive correlation was found between prothrombin fragmant 1.2 and quality of life score. In this study the effectiveness of prothrombin fragmant 1.2 on quality of life and survival time was found. In conclusion; warfarin prophylaxis is effective in improving survival time in lung cancer patients. But further larger studies are necessary for determining the answers to the questions such as warfarin dosage, warfarin usage time, comparative treatment with warfarin and other anticoagulants, and in which stage good response can be seen. Key words: Lung cancer, warfarin, thrombosis, survival time
Açıklama
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases
