Department of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Ann Thorac Surg. 2014 Mar;97(3):965-71. doi: 10.1016/j.athoracsur.2013.11.002. Epub 2014 Jan 11.
Lymphovascular invasion (LVI) is considered a high-risk pathologic feature in resected non-small cell carcinoma (NSCLC). The ability to stratify stage I patients into risk groups may permit refinement of adjuvant treatment recommendations. We performed a systematic review and meta-analysis to evaluate whether the presence of LVI is associated with disease outcome in stage I NSCLC patients.
A systematic search of the literature was performed (1990 to December 2012 in MEDLINE/EMBASE). Two reviewers independently assessed the quality of the articles and extracted data. Pooled hazard ratios (HRs) and 95% confidence intervals (CI) were estimated with a random effects model. Two end points were independently analyzed: recurrence-free survival (RFS) and overall survival (OS). We analyzed unadjusted and adjusted effect estimates, resulting in four separate meta-analyses.
We identified 20 published studies that reported the comparative survival of stage I patients with and without LVI. The unadjusted pooled effect of LVI was significantly associated with worse RFS (HR, 3.63; 95% CI, 1.62 to 8.14) and OS (HR, 2.38; 95% CI, 1.72 to 3.30). Adjusting for potential confounders yielded similar results, with RFS (HR, 2.52; 95% CI, 1.73 to 3.65) and OS (HR, 1.81; 95% CI, 1.53 to 2.14) both significantly worse for patients exhibiting LVI.
The present study indicates that LVI is a strong prognostic indicator for poor outcome for patients with surgically managed stage I lung cancer. Future prospective lung cancer trials with well-defined methods for evaluating LVI are necessary to validate these results.
脉管侵犯（LVI）被认为是切除的非小细胞肺癌（NSCLC）中的一个高风险病理特征。将 I 期患者分层为风险组的能力可能允许对辅助治疗建议进行细化。我们进行了一项系统评价和荟萃分析，以评估 LVI 在 I 期 NSCLC 患者中的存在是否与疾病结局相关。
对文献进行了系统检索（1990 年至 2012 年 12 月在 MEDLINE/EMBASE 中）。两位评审员独立评估了文章的质量并提取了数据。使用随机效应模型估计了汇总风险比（HR）和 95%置信区间（CI）。两个终点独立分析：无复发生存（RFS）和总生存（OS）。我们分析了未经调整和调整后的效应估计值，从而进行了四项独立的荟萃分析。
我们确定了 20 项发表的研究，这些研究报告了 I 期患者有无 LVI 的生存比较。未经调整的 LVI 汇总效应与较差的 RFS（HR，3.63；95%CI，1.62 至 8.14）和 OS（HR，2.38；95%CI，1.72 至 3.30）显著相关。调整潜在混杂因素后得出了类似的结果，LVI 患者的 RFS（HR，2.52；95%CI，1.73 至 3.65）和 OS（HR，1.81；95%CI，1.53 至 2.14）均显著较差。
本研究表明，LVI 是手术治疗 I 期肺癌患者预后不良的一个强有力的预后指标。需要未来前瞻性肺癌试验，采用明确的方法评估 LVI，以验证这些结果。
