Clinical impact of visceral pleural, lymphovascular and perineural invasion in completely resected non-small cell lung cancer

Yılmaz, Aydın; Duyar, Sezgi Şahin; Çakır, Ebru; Aydin, Ertan; Demırağ, Funda; Karakaya, Jale; Yazıcı, Ülkü; Erdoğan, Yurdanur

doi:10.1016/j.ejcts.2010.12.059

Cited by 34 publications

(36 citation statements)

References 22 publications

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“…Previous studies had reported that a number of pathological factors are associated with survival rate, including visceral pleural invasion (33), vascular invasion (34) and perineural invasion (35). In the present study, it was identified that bronchial involvement was an independent predictor of OS and DFS rates, however, the status of pulmonary vascular wall invasion, visceral pleural invasion, lymphovascular invasion and perineural invasion demonstrated no significant association with survival rate.…”

Section: Discussioncontrasting

confidence: 52%

Association between clinicopathological factors and postoperative radiotherapy in patients with completely resected pathological N2 non-small cell lung cancer

Wang

et al. 2017

Oncol Lett

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Abstract. The function of postoperative radiotherapy (PORT) in patients with completely resected pathologically N2 (pN2) non-small cell lung cancer (NSCLC) remains controversial due to a lack of prospective studies. The present study aimed to evaluate the efficacy of PORT in completely resected pN2 NSCLC when using modern radiation techniques, and to determine the associations between clinicopathological factors and PORT and survival rates. Following patient selection, 246 out of 269 consecutive patients with pN2 NSCLC were enrolled in the present study, with 88 patients having received postoperative chemotherapy (POCT) and PORT, 90 having received adjuvant chemotherapy, 1 having received adjuvant radiotherapy and the remaining 67 having received no adjuvant therapy. Overall survival (OS), local recurrence-free survival (LRFS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. The median age of the patients was 59 years, overall, 175 (71.1%) of the patients were male and the median radiation dose was 50.4 Gy. The median follow-up duration was 38.3 months. The 1-, 3-and 5-year OS rates were 98.9, 71.3 and 54.9%, and 93.0, 58.4 and 36.7% (P=0.011) in the PORT and non-PORT group, respectively. The 1-, 3-and 5-year LRFS rates were 95.5, 84.6 and 78.0%, and 86.6, 70.6 and 52.8% (P<0.001) in the PORT and non-PORT groups, respectively. The 1-, 3-and 5-year DFS rates were 86.5, 55.2 and 37.9%, and 80.9, 40.3 and 26.8% (P=0.132) in the PORT and non-PORT groups, respectively. Univariate analysis revealed that the OS rate was significantly increased in patients with peripheral tumors (P=0.029), pT1-2 (P=0.015), one N2 lymph node (LN) metastasis (P=0.001), single N2 station metastasis (P=0.030), no bronchial involvement (P=0.025), use of PORT (P=0.011) and POCT (P=0.003). Multivariate analysis revealed that PORT (HR, 0.755; 95% CI, 0.498-0.986; P=0.047), POCT (HR, 0.645; 95% CI, 0.420-0.988; P=0.044), bronchial involvement (HR, 1.453; 95% CI, 1.002-2.107; P= 0.049) and ≥2 N2 metastases (HR, 1.969; 95% CI, 1.228-3.157; P= 0.005) were significant independent predictors of OS. Subgroup analysis demonstrated an increased OS rate with PORT only in the patients with positive bronchial involvement and ≥2 N2 LN metastases. The results revealed that PORT may improve the LRFS and OS rates in completely resected pN2 NSCLC, and that the patients with positive bronchial involvement and ≥2 N2 LN metastases may receive more benefit from PORT.

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Section: Discussioncontrasting

confidence: 52%

Association between clinicopathological factors and postoperative radiotherapy in patients with completely resected pathological N2 non-small cell lung cancer

Wang

et al. 2017

Oncol Lett

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“…In literature reports, the reported incidence of perineural invasion was 3-29%. [24][25][26] In our study, the incidence was 7.1% and this result is similar to that reported in the study of Poncelet et al [25] In addition, the majority (6/7, 85.7%) of patients with perineural invasion had tumor cells with moderate to poor differentiation. Because of the limited number of cases, further investigations are still required to identify its clinical significance and to understand the actual mechanism of perineural invasion that can lead to poor disease-free and overall survival rates.…”

Section: Discussionsupporting

confidence: 81%

“…We further analyzed the characteristic features of tumor cells among patients who underwent anatomic resection, in order to identify its effect on disease-free and overall survival rates. Previous studies had reported that several pathological factors were related to survival rate; these factors include visceral pleural invasion, [19][20][21][22] vascular invasion, [23] perineural invasion, [24][25][26] histologic grade, [27] and nuclear atypia. [28] Our multivariate analysis indicated that only perineural invasion had a significant effect on disease-free and overall survival rates among N2 NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in resectable pathological N2 disease of non-small cell lung cancer

Hsieh

Liu

et al. 2015

Biomed J

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“…There were no significant associations between skip N2 metastasis and surgical or pathological PL factor or tumor diameter in this study. One mechanism of skip N2 is pleural lymphatic flow [27], and ly and v factors have been reported to predict lymph node metastasis in NSCLC [32]. Therefore, we investigated whether distance to pleura or intersegmental plane, ly factor, or v factor were important predictors of skip N2 metastasis.…”

Section: Discussionmentioning

confidence: 99%

Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer

et al. 2013

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Background: Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC. Methods: From 1998 to 2011, 279 patients (155 men and 124 women) with c-stage IA NSCLC (230 pN0, 17 pN1, 12 skip N2, 20 non-skip N2) underwent systematic lobectomy (R0 resection) at our institute. We compared preoperative serum concentrations of carcinoembryonic antigen, cytokeratin 19 fragment, sialyl Lewis X (SLX), and preand intraoperative clinicopathological features of pN0 and skip N2 patients. Receiver operator characteristic (ROC) curve analysis was performed to distinguish between the two patient groups. Results: The 5-year survival rate of skip N2 patients was 78.6%, higher than that of non-skip N2 patients (44.9%), and not significantly different than that of pN0 (86.7%) or pN1 patients (82.4%). The mean serum SLX concentration in skip N2 patients (28.0 U/ml) was elevated compared to that in pN0 patients (22.9 U/ml). In ROC analysis of SLX, the area under the curve was 0.710, and the optimal cut-off value was 21.4 U/ml (sensitivity, 91.7%; specificity, 51.7%). In multivariate analysis, SLX was an independent predictor of skip N2 in patients with c-stage IA NSCLC (odds ratio, 9.43; p = 0.006). Conclusions: Skip N2 metastasis is common in patients with c-stage IA NSCLC with high serum SLX, and lobectomy with complete dissection of hilar and mediastinal lymph nodes should remain the standard surgical procedure for these cases.

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Clinical impact of visceral pleural, lymphovascular and perineural invasion in completely resected non-small cell lung cancer

Abstract: The presence of visceral pleural or lymphovascular invasion can show higher risk of mortality whereas perineural invasion has no effect on prognosis.

Cited by 34 publications

References 22 publications

Association between clinicopathological factors and postoperative radiotherapy in patients with completely resected pathological N2 non-small cell lung cancer

Association between clinicopathological factors and postoperative radiotherapy in patients with completely resected pathological N2 non-small cell lung cancer

Prognostic factors in resectable pathological N2 disease of non-small cell lung cancer

Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer

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