Microscopic vessel invasion and visceral pleural invasion are correlated with EMT, cancer stemness and resistance to therapy in lung adenocarcinoma

Abstract

Introduction: Visceral pleural invasion (VPI) is included in the TNM classification in NSCLC, while microscopic vessel invasion (MVI) is not incorporated in it. EMT and cancer stemness (CS) are known to be malignant phenotypes to induce resistant to cancer therapy. Objectives: We aimed to assess the prognostic significance of MVI and correlations among MVI/VPI, EMT, CS and treatment resistance. Methods: From 2002 to 2014, 1034 consecutive patients with pathological T1-4N0-2M0 lung adenocarcinoma underwent complete resection. We established 206 tissue microarray (TMA) samples from 2002 to 2007. We evaluated the prognostic impact of MVI including conventional clinicopathological factors, and analyzed MVI/VPI, EMT, CS and treatment resistance by immunohistochemical staining of TMA. Results: Among 1034 cases, the proportion of patients with a 5-year recurrence-free period was 46.1% and 84.5% (MVI: +/−; P Conclusions: MVI and VPI were correlated with EMT and CS and resistance to therapy.