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Microscopic vascular invasion predicts poor outcomes for patients with NSCLC
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Microscopic vascular invasion served as a strong predictor of recurrence and poor survival among patients with non–small cell lung cancer, according to results of a retrospective study.
The association appeared strongest among those with tumors 5 cm or larger, results showed.
Yoshihisa Shimada, MD, PhD, of the department of thoracic surgery at Tokyo Medical University Hospital, and colleagues evaluated data from 1,884 adults (median age, 67 years) with pT1-4N0-2 NSCLC who underwent complete resection.
Researchers used the Kaplan-Meier method to predict survival and a Cox regression analysis to analyze predictors of poor outcomes.
More than half (58.2%) of study participants had microscopic vascular invasion (MVI).
The likelihood of MVI increased with tumor size. Researchers calculated MVI incidence of 35.3% among patients with tumors 2 cm or smaller; 60.3% among those with tumors larger than 2 cm but no more than 3 cm; 76.6% among those with tumors larger than 3 cm but no more than 5 cm; 76.4% among those with tumors larger than 5 cm but no more than 7 cm; and 76.6% among those with tumors larger than 7 cm.
Other factors significantly associated with MVI included older age (P = .001), male sex (P < .001), smoking (P < .001), advanced T classification (T1 vs. T2-4, P < .001) and lymph node metastasis (N0 vs. N1-2, P < .001).
Multivariate analysis showed a significant association between MVI and poorer OS (HR = 1.66; P < .001), as well as between MVI and risk for recurrence (HR = 2.26; P < .001).
Individuals without MVI appeared more likely to achieve 5-year RFS than those with MVI, and the association persisted regardless of tumor size: 2 cm or smaller (93% vs. 7.2%, P < .001); larger than 2 cm but no more than 3 cm (90.8% vs. 63.3%; P < .001); and larger than 3 cm but no more than 5 cm (86.4% vs. 59.9%; P < .001).
“This study demonstrated that MVI was a strong independent predictor of recurrence and poor OS in patients with pathological T1-4N0-2M0 NSCLC,” Shimada and colleagues wrote. “The impact is more prominent in early-stage NSCLC with tumor sizes ≤5 cm. Standard methods for evaluating MVI need to be established, and further data regarding survival outcomes for patients with and without MVI will need to be collected for future revision of the TNM staging system.” –by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
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