title: Prognostic impact and initial recurrence site of lymphovascular and visceral pleural invasion in surgically resected stage I non-small-cell lung carcinoma.
abstract: OBJECTIVE
  This study aimed to analyse and validate the prognostic impact and effect of the initial recurrence site of lymphovascular and visceral pleural invasion (VPI) on survival outcomes for Stage I non-small-cell lung carcinoma (NSCLC).
  
  
  METHODS
  We retrospectively reviewed 433 patients undergoing resection of Stage I NSCLC. The relationship between the clinicopathological background and the pathological variables, lymphovascular invasion (LVI) and VPI, was evaluated by univariate and multivariate analyses.
  
  
  RESULTS
  Lymphovascular and VPI was observed in 41 and 45 patients, respectively. On univariate analysis, the presence of LVI was associated with a significant decrease in relapse-free survival (RFS) (P < 0.001) and overall survival (OS) (P < 0.001). The RFS of the patients of Stage IB with LVI was worse than the RFS of those of Stage IIA (T2aN1 and T2bN0)/IIB (T3N0), and similar to the RFS of those of Stage IIB (T2bN1). The presence of VPI was also associated with a significant decrease in RFS (P < 0.001) and OS (P = 0.01). On multivariate analysis, LVI was found to be an independent predictor of both decreased RFS and decreased OS. However, VPI was not an independent predictor of both. Recurrence was seen in 68 patients. As an initial recurrence site, distant recurrence was seen in 32 patients and local recurrence, in 36. The proportion of local recurrence was significantly higher in the patients with VPI than in those without VPI compared with between the patients with LVI and those without LVI.
  
  
  CONCLUSIONS
  We propose that LVI and/or VPI may be a candidate marker to determine adjuvant therapy or a more careful follow-up for these patients.
authors.affiliation: Department of Pathology and Laboratory Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan. nyanagaw@ypch.gr.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Yanagawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shiono
authors.forename: Masami
authors.initials: M
authors.lastname: Abiko
authors.forename: Shin-ya
authors.initials: SY
authors.lastname: Ogata
authors.forename: Toru
authors.initials: T
authors.lastname: Sato
authors.forename: Gen
authors.initials: G
authors.lastname: Tamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010994:Pleura / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies
keywords: Lymphovascular invasion; Non-small-cell lung carcinoma; Prognosis; Stage I; Visceral pleural invasion