Biesinger Melanie, Eicken Nele, Varga Alexander, Weber Michael, Brndiar Milos, Erd Georg, Errhalt Peter, Hackner Klaus, Hintermair Sarah, Petter-Puchner Alexander, Scheed Axel, Stubenberger Elisabeth, Ghanim Bahil
Department of General and Thoracic Surgery, Karl Landsteiner University of Health Sciences, University Hospital Krems, 3500 Krems an der Donau, Austria.
Statistics Consultancy, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria.
Cancers (Basel). 2022 Apr 8;14(8):1893. doi: 10.3390/cancers14081893.
Lung cancer is the most frequent cause of cancer-related death worldwide. The patient’s outcome depends on tumor size, lymph node involvement and metastatic spread at the time of diagnosis. The prognostic value of lymph and blood vessel invasion, however, is still insufficiently investigated. We retrospectively examined the invasion of lymph vessels and blood vessels separately as two possible prognostic factors in 160 patients who underwent a video-assisted thoracoscopic lobectomy for non-small-cell lung cancer at our institution between 2014 and 2019. Lymph vessel invasion was significantly associated with the UICC stage, lymph node involvement, tumor dedifferentiation, blood vessel invasion and recurrence. Blood vessel invasion tended to be negative prognostic, but missed the level of significance (p = 0.108). Lymph vessel invasion, on the other hand, proved to be a prognostic factor for both histological subtypes, adenocarcinoma (p < 0.001) as well as squamous cell carcinoma (p = 0.018). After multivariate analysis apart from the UICC stage, only lymph vessel invasion remained independently prognostic (p = 0.018). Remarkably, we found analogue survival curve progressions of patients with stage I, with lymph vessel invasion, compared to stage II non-small-cell lung cancer. After further validation in prospective studies, lymph vessel invasion might be considered as an upstaging factor in resectable lung cancer. Especially in the early-stage of the disease, it might represent an additional risk factor to consider adjuvant therapy after surgical resection.
肺癌是全球癌症相关死亡的最常见原因。患者的预后取决于诊断时的肿瘤大小、淋巴结受累情况和转移扩散情况。然而，淋巴管和血管侵犯的预后价值仍未得到充分研究。我们回顾性地分别研究了淋巴管侵犯和血管侵犯这两个可能的预后因素，研究对象为2014年至2019年间在我院接受电视辅助胸腔镜肺叶切除术治疗非小细胞肺癌的160例患者。淋巴管侵犯与国际抗癌联盟（UICC）分期、淋巴结受累、肿瘤去分化、血管侵犯和复发显著相关。血管侵犯往往具有不良预后，但未达到显著水平（p = 0.108）。另一方面，淋巴管侵犯被证明是腺癌（p < 0.001）和鳞状细胞癌（p = 0.018）这两种组织学亚型的预后因素。多因素分析后，除UICC分期外，只有淋巴管侵犯仍具有独立的预后价值（p = 0.018）。值得注意的是，我们发现I期伴有淋巴管侵犯的患者与II期非小细胞肺癌患者的生存曲线进展相似。在前瞻性研究中进一步验证后，淋巴管侵犯可被视为可切除肺癌的分期上调因素。特别是在疾病的早期阶段，它可能是考虑手术切除后辅助治疗的一个额外危险因素。
