Invasion of Blood Vessels As Significant Prognostic Factor in Radically Resected T1-3N0M0 Non-small-cell Lung Cancer

Objectives: Radical resection is the therapy of choice in non-small-cell lung cancer (NSCLC). However, even in early stages (T1N0, T2N0) up to 35% of patients will experience recurrence. The aim of this retrospective study was to evaluate the prognostic influence of lymph vessel or blood vessel invasion in N0 patients.

Methods: A total of 72 patients (male, 49; female, 23; median age 59; range 40-72) with NSCLC entered the study. The stages were T1-3N0 (T1, 25; T2, 41; T3, 6). Thirteen pneumonectomies and 59 lobectomies or bilobectomies with systematic lymphadenectomy and R0 resection were performed. Histologically, 24 adenocarcinomas, 31 squamous cell carcinomas and 14 subtypes of large cell carcinoma were found. In 22 cases microscopic invasion of the lymphatic vessels and in 11 invasions of blood vessels were found. Six patients showed invasion of either structure.

Results: The patients were followed up for at least 5 years or until death. During the follow-up period 27 patients died (21 because of recurrence and 6 because of diagnosis not related to NSCLC). The 5 years overall survival amounted to 62.5%. In cases with invasion of the blood vessels the survival rate was 23.5%, in cases without invasion 74.5% (P< or = 0.01), whereas lymph vessel invasion had no significant impact on survival. Multivariate analysis covering T stages, histological subtypes, location of the tumor, grading, age, sex, and invasion of the lymphatic or the blood vessels showed invasion of the blood vessels as the only factor with significant prognostic impact in the study population.

Conclusions: In resectable N0 patients with NSCLC the microscopic invasion of blood vessels should be considered as an additional prognostic parameter.