• Chest · Mar 2016

    The frequency and prognostic impact of pathological microscopic vascular invasion according to tumor size in non-small cell lung cancer.

    • Yoshihisa Shimada, Hisashi Saji, Yasufumi Kato, Yujin Kudo, Junichi Maeda, Koichi Yoshida, Masaru Hagiwara, Jun Matsubayashi, Masatoshi Kakihana, Naohiro Kajiwara, Tatsuo Ohira, and Norihiko Ikeda.
    • Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan. Electronic address: zenkyu@za3.so-net.ne.jp.
    • Chest. 2016 Mar 1; 149 (3): 775-85.

    BackgroundMicroscopic vascular invasion (MVI) in patients with non-small cell lung cancer (NSCLC) has been reported to be a strong predictor of poor outcomes but it has not been a descriptor of the TNM classification. The purposes of this study were to determine whether the presence of MVI is related to a predictor of poor outcomes and to explore the degree of MVI according to tumor size.MethodsA total of 1,884 patients with stage pT1-4N0-2 NSCLC who underwent complete resection comprised the study sample. Overall survival (OS) and recurrence-free proportion were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to assess independent predictors of poor outcomes.ResultsOf 1,884 patients, 1,097 (58.2%) had MVI. Multivariate analysis showed MVI was a significant independent predictor of unfavorable OS (hazard ratio, 1.666; P < .001) and recurrence (hazard ratio, 2.268; P < .001). The frequency of MVI varied according to tumor size, and in each cohort of tumor sizes ≤ 2 cm, > 2 to 3 cm, and > 3 to 5 cm, there were significant differences in survival outcome by MVI status. The proportions of patients with a 5-year recurrence-free period with tumor sizes ≤ 2 cm, > 2 to 3 cm, and > 3 to 5 cm between MVI (+) and MVI (-) were 93.0% and 72.5% (P < .001), 90.8% and 63.3% (P < .001), and 86.4% and 59.9% (P < .001), respectively.ConclusionsThis study demonstrated that MVI was a strong predictor of poor outcomes and that the effect is more prominent in patients with tumor sizes ≤ 5 cm. Further analysis of survival and MVI should be collected for future revision of the TNM system.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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