Artigo Original\Original Article
Cancro do pulmão de não pequenas células – Comparação entre o estadiamento clínico e o patológico
Non small cell lung cancer – Comparison between clinical and pathological staging
G. Fernandes1,
, M. Sucena2, E. Lombardia2, A. Machado2, V. Hespanhol3,4, H. Queiroga3,5
Corresponding author
gabrielafer@netcabo.pt
Correspondência/Correspondence to: Gabriela Fernandes, Serviço de Pneumologia do Hospital de São João Alameda Professor Hernâni Monteiro 4202-451 Porto. Telefone: 225512214
Correspondência/Correspondence to: Gabriela Fernandes, Serviço de Pneumologia do Hospital de São João Alameda Professor Hernâni Monteiro 4202-451 Porto. Telefone: 225512214
1 Interna Complementar de Pneumologia / Complementary Pulmonology Intern, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto
2 Assistente Hospitalar de Pneumologia / Hospital Assistant, Pulmonology Graduate, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto
3 Assistente Hospitalar Graduado de Pneumologia / Hospital Assistant, Pulmonology Graduate, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto
4 Professor Auxiliar de Medicina da Faculdade de Medicina / Assistant Professor of Medicine, Medical School, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto
5 Professor Associado de Medicina da Faculdade de Medicina / Associate Professor of Medicine, Medical School, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto
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Lombardia, A. Machado, V. Hespanhol, H. Queiroga" "autores" => array:6 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Fernandes" "email" => array:1 [ 0 => "gabrielafer@netcabo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Sucena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Lombardia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Machado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 4 => array:3 [ "nombre" => "V." 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Faculdade de Medicina da Universidade do Porto" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Assistente Hospitalar Graduado de Pneumologia / Hospital Assistant, Pulmonology Graduate, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Professor Auxiliar de Medicina da Faculdade de Medicina / Assistant Professor of Medicine, Medical School, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Professor Associado de Medicina da Faculdade de Medicina / Associate Professor of Medicine, Medical School, Serviço de Pneumologia do Hospital de São João. Faculdade de Medicina da Universidade do Porto" "etiqueta" => "5" "identificador" => "af0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência/Correspondence to:</span> Gabriela Fernandes, Serviço de Pneumologia do Hospital de São João Alameda Professor Hernâni Monteiro 4202-451 Porto. Telefone: 225512214" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Non small cell lung cancer – Comparison between clinical and pathological staging" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-09-05" "fechaAceptado" => "2006-04-26" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec567759" "palabras" => array:3 [ 0 => "Cancro do pulmão" 1 => "estadiamento clínico" 2 => "estadiamento patológico" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec567758" "palabras" => array:3 [ 0 => "Lung cancer" 1 => "clinical staging" 2 => "pathological staging" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">O estadiamento do cancro do pulmão (CP) permanece um desafio clínico, sendo fundamental para estabelecer o prognóstico e a terapêutica da doença. É reconhecido que o tratamento cirúrgico do cancro de pulmão de não pequenas células (CPNPC) constitui a única estratégia com potencial curativo. Neste âmbito, pretende-se, com o estadiamento, seleccionar correctamente os doentes que beneficiarão de cirurgia, evitando submeter doentes inoperáveis a cirurgias desnecessárias e, simultaneamente, não excluindo doentes com lesões potencialmente ressecáveis.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">O objectivo principal deste estudo foi comparar o estadiamento TNM clínico (TNMc) com o estadiamento TNM anatomopatológico (TNMp) e avaliar aspectos do diagnóstico, tratamento e sobrevida dos doentes.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Consistiu num estudo retrospectivo de doentes com CPNPC ou com lesões altamente suspeitas, submetidos a cirurgia, seguidos na Consulta de Pneumologia Oncológica do Hospital de São João, de Janeiro de 1999 a Dezembro de 2003; baseou-se na revisão de processos clínicos e de relatórios anatomopatológicos.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Foram incluídos 60 doentes, 73,3% do sexo masculino, com mediana de idades de 59,5 anos. Os TNMc mais frequentes foram: T1N0M0 em 41,7% e T2N0M0 em 36,7%. Foi efectuada toracotomia com objectivo terapêutico em 80% dos doentes; nos restantes 20% esta foi também diagnóstica. Em 6,7% dos casos, a ressecção foi incompleta. Quanto ao TNMp, os mais frequentes foram: T2N0p em 33,3%, T2N1p em 15,0% e T2N2p em 13,3%. Quando comparados, verificou-se que a diferença entre os estadiamentos foi significativa, tendo ocorrido subida de estádio em 65,0% e descida em 6,7%; apenas 28,3% mantiveram o mesmo estádio. As principais alterações foram de T1N0c para T2N0p e de T2N0c para T2N1p. A concordância global entre os dois métodos de estadiamento foi de 21,7%. A sobrevida mediana global foi de 43 meses.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Em conclusão, o estadiamento clínico revelou-se menos rigoroso, apesar de não ter condicionado importante alteração na estratégia terapêutica nem na sobrevida. No futuro, será necessário considerar outros meios de estadiamento, bem como factores biológicos, para além dos anatómicos actualmente usados.</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2006; XII (4): 337-357</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Lung cancer (LC) staging remains a clinical challenge as it determines the disease’s prognosis and treatment. Surgery is the best option for controlling non-small cell lung cancer (NSCLC) and the only potential cure. In this setting, lung cancer staging helps select patients who will benefit from surgery, excluding inoperable patients and including patients with resectable lesions. The aim of this study is to compare clinical staging (TNMc) with pathological staging (TNMp) and to evaluate diagnosis, complementary treatment and survival of these patients.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective study that included patients with non-small cell lung cancer or with highly suspicious lesions who had undergone surgery and were followed up in the Hospital de São João lung cancer unit between January 1999 and December 2003. It is based on clinical files and pathology reports.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">73.3% of this group of 60 patients were male, with median age 59.2<span class="elsevierStyleHsp" style=""></span>years. The most frequent TNMc stages were 41.7% T1N0M0 and 36.7% T2N0M0. Thoracotomy for therapeutic purpose was performed in 80% and thoracotomy for diagnostic purpose also in the remaining 20%. In 6.7% the resection was incomplete. The most frequent TNMp stages were T2N0p in 33.3%, T2N1p in 15.0% and T2N2p in 13.3%. There was a significant difference between the two staging types, with upstaging in 65.0%, down staging in 67% and only 28.3% keeping the same stage. The most frequent differences were from T1N0c to T2N0p and from T2N0c to T2N1p. The global agreement between both staging methods was 21.7%. Median global survival was 43 months.</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">In conclusion, while clinical staging was less accurate, it did not determine important changes in therapeutic strategy and survival. For the future, we should consider using other diagnostic tools and other biological factors to complement the anatomical information that we currently use.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2006; XII (4): 337-357</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revisions in the international system for staging lung cancer Chest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.F. 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Article information
ISSN: 08732159Original language: Portuguese
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| 2018 June | 45 | 15 | 60 |
| 2018 May | 47 | 13 | 60 |
| 2018 April | 72 | 31 | 103 |
| 2018 March | 38 | 25 | 63 |
| 2018 February | 37 | 8 | 45 |
| 2018 January | 31 | 14 | 45 |
| 2017 December | 36 | 12 | 48 |
| 2017 November | 40 | 15 | 55 |
| 2017 October | 25 | 12 | 37 |
| 2017 September | 30 | 16 | 46 |
| 2017 August | 26 | 19 | 45 |
| 2017 July | 19 | 11 | 30 |
| 2017 June | 28 | 13 | 41 |
| 2017 May | 27 | 13 | 40 |
| 2017 April | 15 | 18 | 33 |
| 2017 March | 22 | 12 | 34 |
| 2017 February | 10 | 6 | 16 |
| 2017 January | 10 | 3 | 13 |
| 2016 December | 13 | 5 | 18 |
| 2016 November | 9 | 7 | 16 |
| 2016 October | 13 | 5 | 18 |
| 2016 September | 0 | 1 | 1 |
| 2016 August | 2 | 2 | 4 |
| 2016 July | 3 | 5 | 8 |
| 2016 June | 2 | 3 | 5 |
| 2016 April | 6 | 7 | 13 |
| 2016 March | 4 | 6 | 10 |
| 2016 February | 9 | 6 | 15 |
| 2016 January | 5 | 7 | 12 |
| 2015 December | 9 | 2 | 11 |
| 2015 November | 1 | 2 | 3 |
| 2015 October | 2 | 1 | 3 |
Show all
