Abstract
Background
Lymphovascular invasion (LVI) is an adverse prognostic feature in resected stage I
non-small cell lung cancer (NSCLC); however, it is unclear if the prognostic significance
applies to both lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC).
Materials and Methods
A retrospective review of H&E-stained slides from surgically resected AJCC 8th ed. stage IA2-IB LUAD (n = 344) and LUSC (n = 102) from two institutions was performed.
LVI was defined as either lymphatic (LI) or vascular (VI) invasion. Outcomes were
assessed by 5-year recurrence-free survival (RFS) estimates using the Kaplan-Meier
method.
Results
The cohorts of LUAD and LUSC showed no significant differences in 5-year RFS (81%
each), stage, age, race, or surgical procedure. The presence of LVI, VI, and LI was
predictive of 5-year RFS for LUAD (LVI + 71% vs. LVI - 92%, P < 0.001; VI + 64% vs. VI - 90%, P < 0.001; LI + 75% vs. LI - 84%, P = 0.030) but not LUSC (LVI + 84% vs. LVI - 79%, P = 0.740; VI + 83% vs. VI- 80%, P = 0.852; LI + 84% vs. LI - 81%, P = 0.757). Among LUAD with LVI, VI was a stronger predictor of 5-year RFS than the
remaining subset of VI-LI + tumors (64% vs. 87%, P = 004). Subset analysis of LI among LUAD stratified by VI showed no significant prognostic
advantage to adding LI for risk stratification (VI-LI + 87% vs. VI-LI - 92%, P = 0.347 & VI+LI + 62% vs. VI + LI- 66%, P = 0.422). VI was present in 36% of LUAD.
Conclusion
Vascular invasion is a strong predictor of recurrence in stage IA2-IB LUAD but not
in LUSC. Adjuvant therapy trials should be directed at this subgroup.
Keywords
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Article info
Publication history
Published online: December 25, 2022
Accepted:
December 20,
2022
Received in revised form:
December 2,
2022
Received:
August 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
