Blood Vessel Invasion: An Underestimated Factor in Determination of Adjuvant Therapy for NSCLC Patients

Background: Non-small cell lung cancer is still one of the leading causes for death worldwide. Therapy-determining staging systems underlie necessarily continuous reevaluation. In particular, tumor size, lymph node involvement, and distant metastasis are paramount in defining therapy. Recent studies have shown that hemangiosis carcinomatosa (V1) impacts the long-term survival of patients with non-small cell lung cancer (NSCLC). The aim of the present study was to emphasize blood-vessel invasion (BVI) as an independent risk factor. We analyzed the effect of V1 on survival in UICC stage I, II and III postoperative NSCLC-patients.

Method: This retrospective study consists of 747 consecutive patients with NSCLC, who underwent an anatomical resection and radical lymphadenectomy at our institution between January 2012 and December 2020. V1 patients were compared with V0 patients (no hemangiosis carcinomatosa). All patients received adjuvant chemotherapy according to European guidelines. One-, 3-, and 5-year survival rates were assessed by Kaplan–Meier method. To prove V1 as an independent risk factor, a propensity score–matched analysis was performed regarding specific properties like age, sex, UICC stage, lymph-node involvement, and comorbidities.

Results: A total of 461 patients (V0: 440; V1: 21) were included in this analysis. Baseline characteristics were comparable. Mean age in V0 group was 65.7 ± 10.5 years and 64.1 ± 8.6 years in V1 group (p = 0.5). 54.8% of V0 patients were male, while 66.7% were male in V1 group (p = 0.37). Mean survival in V1 group was significantly shorter compared with V0 group (V1: 45.8 ± 9.3 months; V0: 81.1 ± 1.1 months; p < 0.001). This was confirmed by propensity score–matched analysis (V0: 99.9 ± 4.9 months; V1: 45.7 ± 9.3 months; p < 0.001). One-, 3-, and 5-year survival rates were significantly shorter for V1 patients (1-year: V0: 100%; V1: 70.6%; p = 0.012) (3-year: V0: 95.2%; V1: 46.2.9%; p = 0.002) (5-year: V0: 90.5%; V1: 36.4%; p = 0.003).

Conclusion: V1 is an independent risk factor for long-term survival for patients with NSCLC. Therefore, we suggest including V0/V1 in pathological reports. BVI should have an impact on adjuvant therapy in NSCLC patients.

Publication History

Article published online:
03 February 2022