The Effect of Blood Vessel Invasion on Prognosis of Operated Stage I Non-small Cell Lung Cancer Patients

Abstract

Objective: A retrospective study was conducted to identify the effect of blood vessel invasion on prognosis in surgically treated stage I non-small cell lung cancer patients. Methods: A total of 71 consecutive patients who had undergone complete resection for stage I primary non-small cell lung cancer (NSCLC) between 1998 and 2007 were evaluated. All pathological specimens were examined for evidence of blood vessel invasion. The follow-up period was 5–118 months. Survival data were analyzed for all patients using the Kaplan-Meier test. Results: There were 63 men and 8 women (mean age 59.2, age range 35–86). The most common tumor types were adenocarcinoma (35 patients, 49 %) and squamous cell carcinoma (26 patients, 37 %). Twenty-five patients (35 %) had stage IA disease, and 46 had (65 %) stage IB disease. In 13 cases (18 %) blood vessel invasion was demonstrated, whereas in the remaining 58 cases there was no evidence of vascular invasion. Minimum and maximum follow-up periods were 5 and 118 months respectively, with a mean of 41.76 ± 27 months (median 33.5 months). Overall disease-free survival was 79.6 ± 6.4 months: 38.3 ± 12.0 months for the group with blood vessel invasion and 87.5 ± 6.7 months for the remaining group. The difference between the two groups was statistically significant (p < 0.003). Overall survival rate was 86.7 ± 6.7 months: 44.5 ± 11.3 months for blood vessel invasion group and 98.2 ± 6.2 months for the remaining group. The difference between the two groups was statistically significant (p < 0.001). Conclusion: Vascular invasion can be an important factor for predicting unfavorable prognosis in stage I NSCLC patients.

non‐small cell lung cancer - early stage - blood vessel invasion - prognosis

References

• 1 Gabor S, Renner H, Popper H, Anegg U, Sankin O, Matzi V et al. Invasion of blood vessels as significant prognostic factor in radically resected T1-3N0M0 non-small-cell lung cancer.  Eur J Cardiothorac Surg. 2004;  25 439-442
• 2 Rena O, Oliaro A, Cavallo A, Filosso P L, Donati G, Di Marzio P et al. Stage I non-small cell lung carcinoma: really an early stage?.  Eur J Cardiothorac Surg. 2002;  21 514-519
• 3 Junker K. Prognostic factors in stage I/II non-small cell lung cancer.  Lung Cancer. 2001;  33 (Suppl. 1) 17-24
• 4 Kobayashi N, Toyooka S, Soh J, Ichimura K, Yanai H, Suehisa H et al. Risk factors for recurrence and unfavorable prognosis in patients with stage I non-small cell lung cancer and a tumor diameter of 20 mm or less.  J Thorac Oncol. 2007;  2 808-812
• 5 Okada M, Sakamoto T, Nishio W, Uchino K, Tsubota N. Characteristics and prognosis of patients after resection of non-small cell lung carcinoma measuring 2 cm or less in greatest dimension.  Cancer. 2003;  98 535-541
• 6 Takise A, Kodama T, Shimosato Y, Watanabe S, Suemasu K. Histopathologic prognostic factors in adenocarcinomas of the peripheral lung less than 2 cm in diameter.  Cancer. 1988;  61 2083-2088
• 7 Ichinose Y, Hara N, Ohta M, Yano T, Maeda K, Asoh H et al. Is T factor of the TNM staging system a predominant prognostic factor in pathologic stage I non-small-cell lung cancer? A multivariate prognostic factor analysis of 151 patients.  J Thorac Cardiovasc Surg. 1993;  106 90-94
• 8 Ichinose Y, Yano T, Asoh H, Yokoyama H, Yoshino I, Katsuda Y. Prognostic factors obtained by a pathologic examination in completely resected non-small-cell lung cancer. An analysis in each pathologic stage.  J Thorac Cardiovasc Surg. 1995;  110 601-605
• 9 Ukena D. Chemotherapy in stage I + II non-small cell lung cancer.  Lung Cancer. 2001;  33 (Suppl. 1) 25-28
• 10 Alam N, Darling G, Evans W K, Mackay J A, Shepherd F A. Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care. Adjuvant chemotherapy for completely resected non-small cell lung cancer: a systematic review.  Crit Rev Oncol Hematol. 2006;  58 146-155
• 11 Mountain C F. Revisions in the International System for Staging Lung Cancer.  Chest. 1997;  111 (6) 1710-1717
• 12 Brechot J M, Chevret S, Charpentier M C, Appere de Vecchi C, Capron F, Prudent J et al. Blood vessel and lymphatic vessel invasion in resected non small cell lung carcinoma. Correlation with TNM stage and disease free and overall survival.  Cancer. 1996;  78 (10) 2111-2118
• 13 Shields T W. Prognostic significance of parenchymal lymphatic vessel and blood vessel invasion in carcinoma of the lung.  Surg Gynecol Obstet. 1983;  157 185-190
• 14 Roberts T E, Hasleton P S, Musgrove C, Swindell R, Lawson R A. Vascular invasion in non-small cell lung carcinoma.  J Clin Pathol. 1992;  45 591-593
• 15 Kessler R, Gasser B, Massard G, Roeslin N, Meyer P, Wihlm J M et al. Blood vessel invasion is a major prognostic factor in resected non-small cell lung cancer.  Ann Thorac Surg. 1996;  62 1489-1493
• 16 Macchiarini P, Fontanini G, Hardin M J, Chuanchieh H, Bigini D, Vignati S et al. Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-small-cell lung cancer.  J Thorac Cardiovasc Surg. 1993;  106 80-89
• 17 Pechet T T, Carr S R, Collins J E, Cohn H E, Farber J L. Arterial invasion predicts early mortality in stage I non-small cell lung cancer.  Ann Thorac Surg. 2004;  78 1748-1753
• 18 Scagliotti G. Multimodality approach to early-stage non-small cell lung cancer.  Lung Cancer. 2007;  57 (Suppl. 2) 6-11