Hemangiosis carcinomatosa as an independent risk factor for long-term survival in Non-Small Cell Lung Cancer patients |
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| Affiliation: | 1. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, Kerpener Strasse 62, 50937, Cologne, Germany;2. University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Pathology, Kerpener Strasse 62, 50937, Cologne, Germany;3. University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Strasse 20, 50931, Köln, Germany;1. Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan;2. Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan;1. Barzilai University Medical Center, Ashkelon, Israels;2. Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel;3. Kaplan Medical Center, Hebrew University, Rehovot, Israel;4. Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel;5. Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel;6. Assaf Haroffe Medical Center, Sackler School of Medicine, Tel Aviv University, Zrifin, Israel;7. Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel;8. Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel;9. Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion, Hedera, Israel;10. Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;11. Hadassah Medical Center, Hebrew University, Jerusalem, Israel;12. Ziv Medical Center, Bar Ilan University, Zfat, Israel;13. Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel;1. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA;2. Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA;3. Division of Abdominal Organ Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA |
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| Abstract: | ObjectivesRecent studies have shown that blood vessel invasion (V1) influences the long-term survival of patients with Non-Small Cell Lung Cancer (NSCLC). The aim of the present study was to emphasize V1 as an independent risk factor. We evaluated the effects of V1 on the survival of NSCLC patients with UICC stages I, II, and III after surgery.MethodsThis retrospective study includes 747 consecutive patients with NSCLC who underwent anatomic resection and radical lymphadenectomy at our institution between January 2012 and December 2020. V1- were compared to V0-patients (no blood vessel invasion). All patients received adjuvant therapy according to European guidelines when indicated. After excluding patients with detection of lymphangiosis carcinomatosa, tumor-cells at the resection margin, distant metastases and those, that received neoadjuvant therapy, 1-, 3- and 5- year survival rates were assessed by Kaplan-Meier method. To proof V1 as an independent risk factor, a propensity score matched (PSM) analysis was performed regarding age, gender, UICC-stage, lymph-node involvement, and comorbidities.ResultsA total of 461 patients (V0: 440; V1: 21) were included in this analysis. Baseline characteristics did not show any significant difference. Mean age in V0-group was 65.7 ± 10.5 years and 64.1 ± 8.6 years in V1-group (p-value = 0.5). In the V0-group 54.8% were male, whereas in the V1-group this number was 66.7% (p-value = 0.37). Mean survival in V1-group was significantly shorter compared to V0-group (V1: 45.8 ± 9.3 months; V0: 81.1 ± 1.1 months; p-value<0.001). This was confirmed after applying a propensity score matched analysis (V0: 99.9 ± 4.9 months; V1: 45.8 ± 9.3 months; p-value<0.001) - V1 is a prognostic marker independent of UICC stage. The 1-, 3- and 5-year survival rates were significantly shorter for V1-patients (1-year: V0: 100%; V1: 70.6%; p-value = 0.012) (3-year: V0: 95.2%; V1: 46.2%; p-value = 0.002) (5-year: V0: 90.5%; V1: 36.4%; p-value = 0.003).ConclusionAs we have shown with our investigations, V1 has a major impact on long-term survival in NSCLC patients and furthermore, acts as an independent risk factor. Due to our small but specified sample size, our statement should be confirmed by a multicenter study. In the meantime, we suggest making the implementation of the V0/V1 specification mandatory in the tumor classification. |
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| Keywords: | Blood vessel invasion TNM-Classification Individual therapeutic concept V0" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" absence of blood vessel invasion V1" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" blood vessel invasion ECOG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" Eastern Cooperative Oncology Group COPD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" chronic obstructive pulmonary disease CHD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" coronary heart disease art" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" arterial PY" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" Pack Years UL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" Upper Lobe LL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" Lower Lobe ML" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" Middle Lobe |
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