Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, 230032, China.
Lung Cancer. 2018 Nov;125:245-252. doi: 10.1016/j.lungcan.2018.09.024. Epub 2018 Oct 1.
Lymphovascular invasion (LVI) and Visceral Pleural Invasion (VPI) have been reported to be risk factors for stage I Non-Small Cell Lung Cancer (NSCLC). However, only VPI was incorporated into the current 8th Tumor-Node-Metastasis (TNM) classification. This study aimed to explore the prognostic effect of LVI and VPI on TNM staging in pathological stage I NSCLC.
We retrospectively reviewed 2633 consecutive p-stage I NSCLC patients in the Shanghai Chest Hospital (2008-2012). By using the Kaplan-Meier method and Cox proportional hazard regression model, we identified the correlations between LVI, VPI, and clinical outcomes in p-stage 1 NSCLC.
Of all 2633 p-stage I NSCLC patients, 222 were pathologically diagnosed with LVI and 836 pathologically with VPI. The 5-year recurrence free survival (RFS) and overall survival (OS) rates of patients with LVI was significantly worse compared to those without LVI (61.2% vs 82.0%, p < 0.001; 73.3% vs 88.1%, p < 0.001). The same results emerged for patients with VPI (70.1% vs 85.9%, p < 0.001; 82.3% vs 90.0%, p < 0.001). Using the univariable and multivariable analysis, we found that when tumor diameter was 3 cm or smaller, LVI (RFS: hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.86-3.50; p < .001; OS: HR, 2.53; 95% CI, 1.72-3.71; p < .001) and VPI (RFS: HR, 2.14; 95% CI, 1.71-2.67; p < .001; OS: HR, 1.56; 95% CI, 1.12-2.04; p = 0.01) were significant prognostic factors for RFS and OS. When tumor size was between 3-4 cm, LVI (HR, 1.84; 95% CI, 1.03-3.29; p = 0.039) and VPI (HR, 2.56; 95% CI, 1.61-4.07; p < .001) were associated with inferior OS.
The presence of LVI significantly affected OS and RFS in stage I NSCLC patients. Our results suggested that it might be better to incorporate LVI as a T descriptor as VPI in the further TNM classification.
脉管侵犯（LVI）和脏层胸膜侵犯（VPI）已被报道为非小细胞肺癌（NSCLC）I 期的危险因素。然而，目前的第 8 版肿瘤-淋巴结-转移（TNM）分类仅纳入了 VPI。本研究旨在探讨 LVI 和 VPI 对 I 期 NSCLC 病理分期的预后影响。
我们回顾性分析了上海胸科医院 2633 例连续的 p 期 I 期 NSCLC 患者（2008-2012 年）。采用 Kaplan-Meier 法和 Cox 比例风险回归模型，我们确定了 LVI、VPI 与 p 期 I 期 NSCLC 临床结局之间的相关性。
在所有 2633 例 p 期 I 期 NSCLC 患者中，222 例病理诊断为 LVI，836 例病理诊断为 VPI。有 LVI 的患者 5 年无复发生存率（RFS）和总生存率（OS）明显低于无 LVI 的患者（61.2% vs 82.0%，p<0.001；73.3% vs 88.1%，p<0.001）。有 VPI 的患者也出现了同样的结果（70.1% vs 85.9%，p<0.001；82.3% vs 90.0%，p<0.001）。采用单变量和多变量分析，我们发现当肿瘤直径为 3cm 或更小时，LVI（RFS：风险比[HR]，2.54；95%置信区间[CI]，1.86-3.50；p<0.001；OS：HR，2.53；95% CI，1.72-3.71；p<0.001）和 VPI（RFS：HR，2.14；95% CI，1.71-2.67；p<0.001；OS：HR，1.56；95% CI，1.12-2.04；p=0.01）是 RFS 和 OS 的显著预后因素。当肿瘤大小在 3-4cm 之间时，LVI（HR，1.84；95% CI，1.03-3.29；p=0.039）和 VPI（HR，2.56；95% CI，1.61-4.07；p<0.001）与 OS 不良相关。
LVI 显著影响 I 期 NSCLC 患者的 OS 和 RFS。我们的结果表明，在进一步的 TNM 分类中，LVI 可能更好地作为 VPI 的 T 描述符纳入。
