Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Thorac Cardiovasc Surg. 2013 Oct;146(4):781-7. doi: 10.1016/j.jtcvs.2013.04.037. Epub 2013 Jun 15.
The aim of this study was to assess the influence of lymphatic and vascular invasion on overall survival in patients with surgically resected non-small cell lung cancer (NSCLC) without lymph node and distant metastases.
From January 1999 to December 2009, a total of 190 NSCLC patients with node-negative pT1-pT4 disease underwent radical resection with lymphadenectomy. Pathologic reports were reclassified to the TNM-7 version, and the influence of lymphatic and vascular invasion on overall survival was examined using Kaplan-Meier and adjusted Cox proportional hazards analyses.
Lymphatic invasion was present in 34 (17.9%) and vascular invasion in 28 (14.7%) of 190 cases. Lymphatic and vascular invasions were correlated with higher Union for International Cancer Control stages (P = .056 and P = .011, respectively) and poor differentiated tumors (P = .051 and P = .012, respectively). There was no difference between pT1a and pT1b tumors in the presence of lymphatic (P = .912) or vascular (P = .134) invasion. Survival analyses revealed lymphatic (P < .001) and vascular (P = .008) invasion as statistically significant for the entire study population. Multivariable Cox analysis adjusted for age, Union for International Cancer Control stage, and lymphatic and vascular invasion confirmed lymphatic, but not vascular, invasion as an independent prognostic factor (P < .001; hazard ratio, 3.002; 95% confidence interval, 1.780-5.061). Especially in early stages, lymphatic invasion was associated with poorer overall survival in pT1a (P < .001), pT1b (P = .019), and pT2a (P = .028) tumors.
Lymphatic invasion represents an independent risk factor for node-negative NSCLC. Its implications on therapy decision making should be further evaluated, especially in early stages.
本研究旨在评估非小细胞肺癌（NSCLC）患者手术切除时无淋巴结和远处转移，且存在淋巴管和血管侵犯对总生存的影响。
1999 年 1 月至 2009 年 12 月，共有 190 例淋巴结阴性 pT1-pT4 期 NSCLC 患者接受根治性切除术和淋巴结清扫术。病理报告重新分类为 TNM-7 版本，并使用 Kaplan-Meier 和调整后的 Cox 比例风险分析检查淋巴管和血管侵犯对总生存的影响。
190 例患者中，34 例（17.9%）存在淋巴管侵犯，28 例（14.7%）存在血管侵犯。淋巴管和血管侵犯与更高的国际抗癌联盟分期（P=0.056 和 P=0.011）和低分化肿瘤（P=0.051 和 P=0.012）相关。pT1a 和 pT1b 肿瘤中淋巴管（P=0.912）或血管（P=0.134）侵犯的存在无差异。生存分析显示，淋巴管（P<0.001）和血管（P=0.008）侵犯对整个研究人群具有统计学意义。多变量 Cox 分析调整年龄、国际抗癌联盟分期以及淋巴管和血管侵犯后，证实淋巴管侵犯而不是血管侵犯是独立的预后因素（P<0.001；危险比，3.002；95%置信区间，1.780-5.061）。特别是在早期，淋巴管侵犯与 pT1a（P<0.001）、pT1b（P=0.019）和 pT2a（P=0.028）肿瘤的总生存较差相关。
淋巴管侵犯是非小细胞肺癌的独立危险因素。其对治疗决策的影响应进一步评估，特别是在早期阶段。
