:

: .

, 2015.

2015.

.
,
. ,
.

, , .

, ,
.
, 4% 13 % .
30% 35 %
( 2 % - 5 %).

,
.

. ,

.

,
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.
.
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.
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21% .

,
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2015.

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.
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.
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.
p , . .
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3N0-1 p 30 % 45 %,
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p ,

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/ p.
3

2015.

CD44, (VGF)
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,
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p
p , ,
.

2015.

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:
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NSCLC)
2) (. small cell lung carcinoma SCLC)
(NSCLC)
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, , .

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.

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. ,
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.

2015.

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PCR (. polimerase chain reaction ).

.
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. ,
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.
.
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.

( )
.

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p .30-34
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.
.

.
, ,
.

2015.

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.

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), N0 N3
.

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:

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2015.

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.

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TNM kategorije:
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.

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,

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/ /
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8

2015.

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2015.

HEP , PER , SKI

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:

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0
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2015.
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, 1N00 (I)
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, ,
.

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11

2015.

I II ,
,
. N1
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/
. IIIB



,
, .
III IIIB
. IIIB 4
()
. III

. 115 .
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), ( ,
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2015.

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.
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.) ,
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- .

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.
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:

13

2015.

1
,

1
,

5 %


, 1.
47 % ,
(63 %).
57 %
.11-12
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.


9 %, 18 %.
, ,
,
.
24 %.
,
, . .
8 %, 40
% .
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,
.
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.
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.
14

2015.

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, , .
.
.
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NSCLC
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, . ,
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. ,
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4 ,
.
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, ,
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.
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, ,
.
, ,
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.
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15

2015.

,
, ( I II)
.
,
.
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.

.
I I 65 % .
,
,
.
, ,
.
.

.
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III
.
.

A.

:
I .

, 10 % 3- 4
, .
,
.
40 ,
.
16

2015.

,
. , ,

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III
IV

**

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/P

,
*

*
** , , , N/ (Modifikacija
skale Ihde DC. Non-small cell lung cancer. Biology, diagnosis and staging. Curr Prob Cancer, 1991:15:65)

.
.
, .
, 1.
.

17

2015.

.
1 2.
2 5
.
.

,
I .

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.
,
.
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.
, (1N0)
.
(2N0) .
, ,
.
, ,
. 27 ,
.

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(LDH)

.30


.
.

, ,
.
18

2015.

.
. ,
,
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.

. N N

7,5 % 45 %. ,
, 20 % 35 %.
staginga
(pTNM).59
II
N

II :

N

T1N0M0

60,7%

68,5-75,5%

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37,6%

57,0-59,0%

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33,8%

52,5-54,1%

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23,4%

40,0%

T3N0M0

21,2%

33,3-44,2%

T3N1M0

12,5%

17,6-39,0%

19

T N2M0

4,6%

2015.

15,1-28,8%

.
80 % ( TsiN0, T1N0 ).60

.
: I 55 %, II 29 % III 26,2 %
(Mountain) : 1 50,1 %, 2 40 % 3 31,3 %.61
, 3 14 %.62, 63
.
, 1 2,
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%).64, 65

N
N N
.
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.
N2 . N2
, , 10
%. ,
, 10 %.

19 % 45 %.66 . ,
,
N2 .17

. I 21,6 %
, II III 12,5 % 5,6 %.

20

2015.

, , .
15,7 %,
13,8 % .
I (23% ).17

.
(
),
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, .

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, 1N00 83 %, 2N00
63 %.17
Sleeve
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N2.
, 14 %.80 - 86
, 20%
45%. ,
, .

.
FVC ( 1,3 ) FEV1 ( 0,9 )
, ,
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,
, ,

.
(
) 55 % 69
%.18

32 % 43 %,
.
21

2015.

, 15 %
,
.19

.
(
50 %) (
33 %).19 3N0
38 %, 3N1 3N2 29 % 9 %.19
, , 34 %
.18 , 3
N2 .
10 %, .19
(Pancoast )

. 19,20
N3
, N2, ,
. N
,
.
, 15 %
.20
, N1 N2
.

.

.

. 4,5 N

.
, , .20

22

2015.

,
(
/ )
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, .
.
:




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. 12 - 22
, .

:



,
.
.
, , ,

.
/ (
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, . 29
.
.
. 29 - 31
:

23

2015.

I II
III
,
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I , , :



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. I
. ,
II .
I II
II ( / ).
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. p pN2 (
60 % ). B p
p p p pp ()
pp p.31 , p
p , p p
p. p
p
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, .
pp p pp
, , p
.

1) p, , pp
p p .
N
p.

2) p p p p
pp
.

3)
, , .
.
24

2015.

4) p ex tempore ,
. ,
p
. p .

5) p p
.

, .

.
.
,
,
.

, ,
. ,
/ , ,

.
:

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, ,
:


( ,
).
IIIB 4 N2
N3 . .
25

2015.

n. phrenicus

(N2 ).
n. phrenicus .
4 .
N2
, N3 .
N
.
N
.
2
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.
(4)
.

.

:

,
.
v. cavu superior
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. , ,
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( ).
( 5 %).
N2
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).
.39 - 42

26

2015.

/
, ,
. slevve
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, ,
(1 2)
(N2 ).

.
/ .

. , , ,
.
:
,
. ,
, .
2% 5 % .
, , .
.

.
,
.
, ,

. ,
.

27

2015.

,
(
).
(
).
, .
N2 , ,
. , , ,
(
).
, ,
.243-246
,
, ,
.
,
.

,
. 246-248


.

,
5 % .

, ,
,
. 70
:
.
.

28

2015.

( ) (
).

, .
en block (
), , ,
. ,
v cavae superior .
(
). . 6366

,
( 66% 68 %), ( 26 % 28 %)
( 4 % 8 %).22-26

)

.
, ,
.

.
. 3 %. 70
,
,
.12-17

(N1 N2).
,
,
(


).24
,
,
,

.
29

2015.

Sleeve ,

( ). 27

, .
sleeve , sleeve
. sleeve
.
Sleeve (
),
sleeve .26, 27
Sleeve 5 % .
27, 28

sleeve
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( 17 % 23 % )
.
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)

.

.57,58.59

, 70 .
6 % 11 %,
70 15 %.
,
.

.
.66 :

.

/ ,
v cavae sup
30

2015.

.
sleeve .
.
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25 %, 10 %.28, 29

)
,
.

,
, .
.

, , ,
.29
N .
, .
,
, ,
/ .
, ,
,
/ . 46,47,48
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.
(G1)
.
, ,
. ,
, .

.
31

2015.

, ,
.
() ,
.
.

.

.
.

.

.
(N)

.
,
, .
,
.
(D, Z) ,
, .
. ,
, .

,
4 % 13 % . ,

, : (93 %), (85
%) (63 %).30

32

2015.

,
,
( )
.
,
.
(
).
I II
. , 20 % 25
% , ,
. III III , , . 302-305
III
/ .
4, (
),
.30

III
.

, , , .
, ,
. I,II II
.306-322
,
,
, .
,
,
.
, ,
(),
( ) ,
,
.

:

33

2015.

.


.

, .

.
.
:

.
.
( 50 % ),
15 % . ,
, , . ,
, 10 % 15 %. 31 ,

( 25 % ).
.
.
20 % 60 %,
25 % 35 %
, , 10 %
.320,321
, , .
, MVC (,
/ ) MIC (, ). 32

,
. ,
34

2015.

,
, , , 11, . 32

.
()
.24,25

:
, .
.

.
.
, , .
WHO 0, 1 2 y 70 %.
.
III ,
. ,
III , ,
. 23 - 26
. III 3,
, ( Pancoast
) 2 .
, N2 .
.
III 3,
N2 .
, N2
. N2 (
),
, , (
).
, , .

, N2 ,
N2
N2,
. N2 ,
.
35

2015.

60 % , 40 % . 28 - 30 ,
, ,
, .18 ,
, ,
, . 16 ,17

.
. ,
,
. , ,
,
, .
50 %

.
. ,
()
, .
.
, ,
.
III N2
,
,
, , .

.
(
6 ),
.

.

, .

. ,
,
CHART (
NSCLS).

36

2015.

.
,
.
,
. 321
.

.

, .
, ,
1 .

.
2 Gy 55 Gy
.

,
. ,
. ,
,
,
10 %
.
. 17
4 ,
, , , ,
. N3


. III
. 17 , ,
.
, .
by-pass
. Sleeve
.
.
Pancoast ,
.
,
37

2015.

. ,

. ,
, .
,
,
. 326-330
4
( , ,

) 4 (
,
).30-34

.
, , I NSCLC ( ).
1-2N0 65 % 85 %
( ).33-37
NSCLC
.
,
.38-41
3 % 5 %
.338
. 42

,
.
( ), ,
.

(, , , ) , ,
NSCLC.
, .

NSCLC.34-44

38

2015.

. (3 )
18 . 45-48
,
,
.
50 Gy .

, .
, . 49,50

, 1N0
( 85 % 70 %). 51-53
30 % ,
, .
, 50
%
. ,
(
, , ,
).
, 35
% 45 %.
, , ,
.54,55

, .
,
( 80 % 90 % 40 % 60 % ).56-60
.
,
. ,

, (.
). 61-63

, 1-3N0
.
39

2015.

.
: 1-3 N1-2, 4N0-2, WHO 0-1, FEV 1 1.
( )
N2,
40 Gy 60 Gy ,
.61

40

2015.

,

. ,
(I II ).
, .
:

,
.

,
.

:
( I, II ) NSCL ,

41

2015.

.
.
1997 2010 .
1276 . I II
( ) 272 (20,99 %) ,
220 I, II (16,98 % ),
.
:
I, I, II II
.
,
, (
, ).
- G (G1, G2, G3, G1-4)
( < 30 1, 30 50 2
> 50 3).
N (N0
, N1 /
).
y (80 %, 90 % 100 %).

I II ,

.

42

2015.

220 56,41+ 9,06 .
187 (85%) 33 (15%) . ( 1)

1: .
2

2: .
1 , 2 , 3

43

2015.

G, 3.

3: .
4
30, 30 50 50.
30,
30 50. (30%)
50.

4: .
5
.
N0 N1.
/ 57 %

44

2015.

, 43 %
.

5: .
18 % I 82 %
II . 6
.

6:
.
I I (I), I (II)
II II (I), II (II)

45

2015.

. 7 .
,
( 32 % ), ,
( 21 % ), ( 13 % ).
, 2%.

7:
( ), ( ), ( ), (
), ( )

8
. . y ,
80 %, 90 % 100 %.

,
. ( )
80 % 90 % (39 % 51 %).

46

2015.

8: .

9.
II 30 50

9:

I II 10.
II y 90%
(60,95%), II 100% 53,33% .
II 13,33% 80%,
.

47

2015.

10: .
I
, II .

11.

11: NSCLC

48

2015.

,
, ,
. I ,
1 2 (N0). ,
, , 1N00
. 1 3 ,
2 3. ,
,
.
.
,
.
,
. NSCLC
1 2,
.
II
1 2
() . Staging
1997 300 ( III
).
III , 1-3N20 3N10.

. ,
3N00 2N10.
I II
,
. N1
( 53 %) II .
( ) N1 (II ).

. ,
35 %,
, , 9 %.
,
.

49



( 4 ).

2015.

.
,
N2 . ,
.

,
I II .
01.01.1997 01.01.2010 , 272
(20,99 %). , ,
( ,
, 20 % 25 % ).
, ,
220 (16,98 % )
.
85 % 15 % ,
56,4 9,06
.

53 % ,
42 %, (
) 5 %
.
,
, 1 2. ,
,

. .
220 , 50 %
50, 19 %
30. , 30 % 30
50.
,
( 32 %),
.
,
50

2015.

. ,
30.

, , 90
% ,
. 9 %
.

,
,
.
.
,
,
,
, .

51

2015.

,

. ,
, ,

, .
, ,
, , . II SCLC
NSCLC. ,
,
.
:

,
.

,
,
,
.
,
, .


,
,
- .

52

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