Department of Pathology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba-shi, Ibaraki, 305-8575, Japan; Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba-shi, Ibaraki, 305-8575, Japan.
Lung Cancer. 2013 Dec;82(3):407-12. doi: 10.1016/j.lungcan.2013.09.001. Epub 2013 Sep 12.
Vascular invasion (VI) has been accepted as a universally important prognostic factor for patients with lung carcinoma. However, the clinical significance of VI in each of the histological subtypes has been unclear. The aim of the present study was to investigate differences in the clinicopathological implications of VI between adenocarcinoma and squamous cell carcinoma.
A total of 336 patients were evaluated, of whom 81 were diagnosed as having peripheral-type squamous cell carcinoma, and 255 as having adenocarcinoma.
Among the 336 patients, the five-year survival rates for those who were VI-positive and VI-negative were 38.4% and 76.3%, respectively, the difference being significant (p<0.0001). Multivariate analysis identified VI as an independent prognostic factor (hazard ratio: 1.86). Although the difference in cancer-free survival between VI-positive and -negative patients was statistically significant for adenocarcinoma (p<0.0001), it was not significant for squamous cell carcinoma (p=0.086). For adenocarcinoma, the difference between the survival curves for VI-positive and -negative patients was significant for the subtypes with a predominant lepidic (p<0.0001), papillary (p=0.0026), and acinar (p=0.0060) component, whereas that for the predominantly solid subtype was not significant (p=0.58). Squamous cell carcinomas were then divided into two groups on the basis of the diameter of vessels that had been invaded by the cancer cells: large-vessel invasion (LVI; 1000 μm or more) and small-vessel invasion (SVI; less than 1000 μm). Although there was no difference in the survival curves between the LVI and SVI groups, the LVI group showed a significantly higher incidence of cavity formation and distant metastasis.
We conclude that VI is a useful prognostic indicator in lung carcinoma, although the clinical implications of VI differ between adenocarcinoma and squamous cell carcinoma.
血管侵犯（VI）已被普遍认为是肺癌患者的一个重要预后因素。然而，VI 在每种组织学亚型中的临床意义尚不清楚。本研究旨在探讨 VI 在腺癌和鳞癌中的临床病理意义的差异。
共评估了 336 例患者，其中 81 例诊断为周围型鳞癌，255 例诊断为腺癌。
在 336 例患者中，VI 阳性和 VI 阴性患者的 5 年生存率分别为 38.4%和 76.3%，差异有统计学意义（p<0.0001）。多因素分析表明 VI 是独立的预后因素（危险比：1.86）。虽然 VI 阳性和 VI 阴性患者的无癌生存率差异在腺癌中有统计学意义（p<0.0001），但在鳞癌中无统计学意义（p=0.086）。对于腺癌，VI 阳性和 VI 阴性患者的生存曲线之间的差异在以贴壁型（p<0.0001）、乳头状（p=0.0026）和腺泡型（p=0.0060）为主的亚型中具有统计学意义，而在以实体型为主的亚型中则无统计学意义（p=0.58）。然后根据癌细胞侵犯的血管直径将鳞癌分为大血管侵犯（LVI；1000μm 或以上）和小血管侵犯（SVI；小于 1000μm）两组。尽管 LVI 组和 SVI 组的生存曲线无差异，但 LVI 组的腔形成和远处转移发生率明显较高。
我们得出结论，VI 是肺癌的一个有用的预后指标，尽管 VI 在腺癌和鳞癌中的临床意义不同。
