Original article: general thoracic
Nonanatomic prognostic factors in resected nonsmall cell lung carcinoma: the importance of perineural invasion as a new prognostic marker

https://doi.org/10.1016/S0003-4975(03)01645-XGet rights and content

Abstract

Background

A number of prognostic factors have been reported for resected nonsmall cell lung carcinoma. Although none of them reported to have greater prognostic impact than the TNM staging system, which is based on anatomical descriptions of tumors, the prognoses of a significant number of patients are not in agreement with real survival of the patients. Moreover, certain histopathologic properties of the tumor (such as lymphatic and vascular invasion) could help to predict the survival of the patients.

Methods

A retrospective study was conducted on 82 surgically resected nonsmall cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, clinical and surgical-pathologic T and N status, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion.

Results

Lymphatic invasion and perineural invasion of the tumor were found to be significant prognostic factors (p = 0.02 and p = 0004). Blood vessel invasion (venous or arterial involvement) had no prognostic impact (p > 0.05). According to multivariate analyses, three factors were selected as prognostic indicators: (1) clinical N status (p = 0.027), (2) lymphatic invasion (p = 0.027) and (3) perineural invasion (p = 0.0148). By combining these factors we identified a poor prognostic subgroup of patients with stage I disease.

Conclusions

Our study showed that lymphatic vessel and perineural invasion of the tumor could be prognostic factors, along with anatomical determinants such as cN and surgical-pathologic stage of the pulmonary carcinoma.

Section snippets

Patients and methods

Between January 1998 and November 2002, 82 consecutive patients with histologic evidence of NSCLC were enrolled in the study after complete pulmonary resection and lymph node dissection. Routine blood tests included hemoglobin, alkaline phosphatase, and serum calcium estimations. All patients underwent postero-anterior and lateral chest radiographs and bronchoscopy. Computed tomographic scans of the thorax, abdomen (or abdominal ultrasonography), cranium, and all body bone scintigraphies were

Results

The main clinical and pathologic characteristics of the enrolled 82 patients are summarized in Table 1.

For the entire group, the mean follow-up period was 15.9 months (range, 1 to 43 months), and the median survival time was 45 months. The 1- and 3-year actuarial survival rates were 84.7% and 50.9%, respectively (Fig 2).

Univariable analyses revealed the following conventional prognostic factors as significant: surgical and pathologic N status (p = 0.027) and surgical and pathologic stage (p =

Comment

The staging system for NSCLC provides a framework for the assessment of prognosis and the assignment of therapy for all the patients. Similar to previous staging systems, the recent system has been established on a large database [2]. The power of this large database in prognosis is self-evident. Nevertheless, the inherent inaccuracy of the staging process should be brought to attention. According to the recent TNM system, the predicted 5-year survival after complete resection for T1N0 MO NSCLC

References (27)

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