title: Intra-tumoral vascular or perineural invasion as prognostic factors for long-term survival in early stage non-small cell lung carcinoma.
abstract: OBJECTIVE
  In recent studies focusing on the prognostic significance of histologic features of NSCLC tumors, vessel invasion was correlated to survival across all surgical stages. We similarly analyzed whether intra-tumoral permeation could affect survival in subgroups of stage I and II NSCLC.
  
  
  METHODS
  A retrospective single institution analysis of a prospectively computed database. Specimens were analyzed for intra-tumoral vascular, lymphatic and nervous permeation. Overall mortality was determined and for each stage, a Cox regression analysis of selected variables was performed. Detailed histologic information was available in all patients. Follow-up was 100% complete (median=69 months).
  
  
  RESULTS
  From 1989 to 2004, out of 346 patients with stage I and II NSCLC, 253 patients with p stage I (75.7%) and 81 patients with p stage II (24.3%) underwent surgery with complete resection, for a completeness resection rate of 97% (334/346). We performed 70 pneumonectomies, 255 lobectomies and 9 lesser resections (respectively, 21%, 76.3% and 2.7%). In-hospital mortality was 2.1%. The incidence of intra-tumoral permeation was 14.4% (48/334). Permeation correlated both with T status (p=0.04), grade of differentiation (p=0.03) and stage (p=0.02). Median survival and overall 5-year survival for patients with and without permeation were 42.3 months (95% CI [20-64.6]) and 72.1 months (95% CI [56.9-87.2]), respectively; and 44% and 54%, respectively (p=NS). However, intra-tumoral permeation was not a significant predictor for overall death (HR=1.1 [95% CI=0.74-1.66).
  
  
  CONCLUSIONS
  In this large institutional study of early stage NSCLC, the presence of intra-tumoral permeation was correlated both to T, grade of differentiation, as well as to stage. However, in contrast to recent reports, we did not find that intra-tumoral permeation adversely affects long-term survival.
authors: Department of Cardio-Vascular and Thoracic Surgery, UCL Saint Luc Hospital, Brussels, Belgium. Poncelet@chir.ucl.ac.be
authors: Alain J
authors: AJ
authors: Poncelet
authors: Julien
authors: J
authors: Cornet
authors: Corinne
authors: C
authors: Coulon
authors: Philippe
authors: P
authors: Collard
authors: Philippe
authors: P
authors: Noirhomme
authors: Birgit
authors: B
authors: Weynand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008208:Lymphatic System / Q000473:pathology; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009420:Nervous System / Q000473:pathology; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate