Intratumoral Vessel Invasion Research Articles

T1aN0M0 and T1bN0M0 Non–Small Cell Lung Cancer: A Retrospective Study of the Prognosis

Stage IA of non-small cell lung cancer (NSCLC) is divided into two subgroups, T1aN0M0 (d ≤ 2 cm) and T1bN0M0 (2 < d ≤ 3 cm), in the International Association for the Study of Lung Cancer, seventh edition of TNM Classification of Malignant Tumors. The purpose of this study was the identification of independent clinicopathological predictors of prognosis of these two subgroups of NSCLC. Between 1986 and 2005, a cohort of 1,929 cases of stage IA NSCLC in Tian Jin Medical University Cancer Institute and Hospital were retrospectively analyzed. The impact of clinicopathological characteristics on patients' survival was investigated. The overall 5-year survival rate was 71.07%. Patients with T1aN0M0 NSCLC had a better 5-year survival than those with T1bN0M0 (73.98 vs. 68.18%, p = 0.0135). The Cox proportional hazard model revealed that the prognostic factors of T1aN0M0 were intratumoral vessel invasion (p = 0.035) and histologic differentiation (p = 0.004). In patients with T1bN0M0 NSCLC, the prognostic factors were histologic differentiation (p < 0.01), intratumoral vessel invasion (p < 0.01), removal of 6 or more lymph node stations (p < 0.01), and removal of lymph node station 7 (p < 0.01). Prognostic factors of T1aN0M0 and T1bN0M0 NSCLC are different. In patients with T1bN0M0 NSCLC, 6 or more lymph node stations and lymph node station 7 should be removed.

18F-FDG uptake in primary lung cancer as a predictor of intratumoral vessel invasion

This study investigated how fluorodeoxyglucose (FDG) uptake on PET in the primary tumor may predict intratumoral vessel invasion (IVI) in it. A total of 512 patients with lung neoplasms determined by a surgical procedure and histopathological diagnosis had undergone FDG-PET scanning. Among the 440 cases confirmed to be malignant, the maximum standardized uptake value (SUV(max)) was significantly lower in IVI-negative cases than IVI-positive cases (P < 0.001). In the substudy on adenocarcinoma (AC), SUV(max) was significantly lower in IVI-negative cases too (P < 0.001), but SUV(max) in squamous cell carcinoma was without significant difference. In addition, IVI was associated with a significantly higher probability of lymph node metastasis (P < 0.001). This study indicates that a malignant lung tumor with higher SUV(max) has a significantly higher probability of IVI and lymph node metastasis, particularly if the malignancy is an AC.

Long-term Survival and Risk Factors for Recurrence in Stage I Non-small Cell Lung Cancer Patients With Tumors up to 3 cm in Maximum Dimension

The purpose of this study was to evaluate patients with stage I non-small cell lung cancer (NSCLC) and tumors up to 3 cm in maximum dimension who underwent surgical resection on the revised TNM classification and to investigate the risk factors for recurrence. Between 1994 and 2003, 713 consecutive stage I NSCLC patients with tumors up to 3 cm in maximum dimension underwent complete resection. Recurrence-free probability was estimated from the date of the primary tumor resection to the date of the first recurrence or the last follow-up using the Kaplan-Meier method. The recurrence-free probability of stage I NSCLC patients with tumors up to 3 cm in maximum dimension was 87% at 5 years. On multivariate analyses, three variables were shown to be independently significant recurrence risk factors: histologic differentiation (hazard ratio, 2.3), intratumoral vessel invasion (hazard ratio, 2.9), and visceral pleural invasion (VPI) (hazard ratio, 1.8). According to subgroup analyses combining these three risk factors, the 5-year recurrence-free probability was 94% for patients with zero or one factor (n = 492) and 71% for patients with two or three factors (n = 221), respectively (P < .001). In stage I NSCLC patients with tumors up to 3 cm in maximum dimension, we identified three risk factors for recurrence that independently increase their risk of recurrence. In addition to VPI, histologic differentiation and intratumoral vessel invasion should be examined and their data collected for the next revision of the TNM staging system.

Prognostic Significance of Intratumoral Blood Vessel Invasion in Pathologic Stage IA Non-Small Cell Lung Cancer

The 5-year survival rate of pathologic stage IA non-small cell lung cancer (NSCLC) is excellent; however, up to 10% of patients with pathologic stage IA NSCLC still relapse postoperatively and die. This study retrospectively analyzed the clinicopathologic features of patients with pathologic stage IA NSCLC to identify the prognostic factors and investigate the effect of a combination of intratumoral vessel invasion and tumor size. From December 1991 to December 2003, 217 consecutive patients with stage IA NSCLC were selected, and disease-free survival (DFS) was analyzed. Intratumoral blood vessel invasion (BVI) was identified as an independent poor prognostic factor (p = 0.0006). The relative risk for patients with BVI was 4.599 times higher than that for patients without BVI (95% confidence interval, 1.913 to 11.056). According to the new T N M system, the difference in DFS between the patients with and without BVI was statistically significant, not only in tumors exceeding 2 cm (T1b with BVI vs T1b without BVI, p = 0.0020) but also in tumors smaller than 2 cm (T1a with BVI vs T1a without BVI, p < 0.0001). The survival curve of T1b patients without BVI was similar to that of T1a patients without BVI (p = 0.0892). Distant recurrence was frequently observed in both T1a and T1b patients with BVI. BVI is an independent poor prognostic factor in patients with pathologic stage IA NSCLC. These T1a and T1b patients with BVI both might benefit from adjuvant chemotherapy.

Prognostic impact of intratumoral vessel invasion in completely resected pathologic stage I non–small cell lung cancer

Intratumoral vessel invasion of non-small cell lung cancer is a readily available tumor-related factor that provides direct evidence of microscopic tumor invasion. We assessed the prognostic influence of intratumoral vessel invasion and its ability to provide a differential prediction of prognosis for completely resected pathologic stage I non-small cell lung cancer. We analyzed 258 patients with non-small cell lung cancer who underwent complete resection between January of 1996 and December of 2005 and were diagnosed with pathologic stage I disease. In addition to the conventional staging factors, intratumoral vessel invasion in the primary lesion was histologically evaluated by both hematoxylin-eosin and elastic staining. We examined the significance of intratumoral vessel invasion in prognosis and compared the outcomes between patients with and without this factor with stage IA and IB disease, respectively. Intratumoral vessel invasion was found in 124 patients (48%). Five-year survival of patients with or without intratumoral vessel invasion was 74% and 93%, respectively. On multivariate analysis, intratumoral vessel invasion and pleural invasion were shown to be independent prognostic factors. Subgroup analyses suggested that patients with pathologic-stage IA with intratumoral vessel invasion and patients with pathologic-stage IB with both intratumoral vessel and pleural invasion had significantly worse prognosis than patients with the same pathologic stage without these factors. The current study indicated that intratumoral vessel invasion and pleural invasion are independent prognostic factors. Intratumoral vessel invasion status can complement the size-dependent TNM staging system in pathologic stage I non-small cell lung cancer.