title: Little things make big things happen: angiolymphatic invasion and tumor necrosis prognosticate the outcome of locally advanced non-small cell lung cancer treated with a prior induction therapy.
abstract: OBJECTIVE
  Size, invasion of thoracic structures, and ipsilateral mediastinal lymph node involvement (pN2) are well-known prognostic factors that configure the staging of resectable, locally advanced non-small cell lung cancer (LA-NSCLC). The prognostic impact of angiolymphatic invasion (ALI) and tumor necrosis (TN) has been barely explored in LA-NSCLC treated with prior induction therapies.
  
  
  METHODS
  We retrospectively reviewed 47 resected LA-NSCLCs treated with a prior platin-based chemotherapy or chemoradiation. The impact of ALI, TN, and other pathologic features on survival was analyzed.
  
  
  RESULTS
  ALI was presented in 23.4% of cases and TN in 29.8%. Disease-free and overall survival decreased when ALI, TN, or pN2 was present. The incidence of ALI was lower in LA-NSCLC with a good response to induction.
  
  
  CONCLUSIONS
  Our series is the first to report the prognostic impact of ALI and TN in induction-treated LA-NSCLC. The presence of ALI and TN should be included in the pathologic reports.
authors.affiliation: From the Medical Oncology Department and dmarmed@hotmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Marquez-Medina
authors.affiliation: From the Medical Oncology Department and.
authors.forename: Antonio
authors.initials: A
authors.lastname: Martin-Marco
authors.affiliation: Pathology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain, and.
authors.forename: Sonia Gatius
authors.initials: SG
authors.lastname: Caldero
authors.affiliation: Histopathology Department, Royal Brompton and Harefield NHS Trust Foundation and Imperial College of London, London, UK.
authors.forename: Angeles
authors.initials: A
authors.lastname: Montero-Fernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Angiolymphatic invasion; Induction treatment; Locally advanced; Mediastinal lymph node involvement; Non–small cell lung cancer; Tumor necrosis