Lung cancer stage 3b

Purpose: Prognostic and therapeutic decisions regarding resected lung cancer often are based on TNM staging. A further dimension of cancer pathology, vascular invasion, also may influence outcome. To define the significance of this entity, a group of patients undergoing definitive lung resection was studied retrospectively.

Methods: Between 5/94 and 12/98, 205 patients had a lobectomy/ pneumonectomy with lymphadenectomy for primary lung cancer. Patients with wedge resections or exploratory thoracotomy were excluded. This study group was separated into two cohorts: those with pathologic vascular invasion (VI) within pulmonary parenchyma and those without invasion (NOVI). Demographics, clinical features and outcomes were examined in these two cohorts; numerical and categorical data were compared with a nonparametric t test and Fisher's exact test respectively.

Results: Vascular invasion was seen in 67/205 patients (32.7%); In the remaining 138, no VI was observed. There were no significant groups differences in age, gender, race, comorbidity, pack-years smoking, asbestos exposure, immunosuppression or pulmonary function. Those with VI had a higher proportion of advanced stages (2A/2B, 3A/3B) - 27/67 (40.3%) compared to the NOVI groups - 29/13B (21.0%), p=0.04. At a mean follow-up of 22 mo. 22 recurrences (32.8%) were seen in the VI cohort contrasted to 20 (14.5%) in the NOVI group p=0.02. Recurrence by metastasis was seen in 21VI (31.3%) and 17 NOVI (12.3%), p=0.01. In the VI group 37 had adjuvant chemotherapy (chemo) while 30 did not. Metastatic disease was seen in 12/37 (32.4%)treated with chemo and 9/30 (30.0%) receiving no treatment, p=1.0.

Conclusion: The presence of VI in resected specimens of lung cancer portends a more aggressive neoplasm. In the short term, metastatic recurrence is increased compared to those without VI. Those with VI have a more advanced stage at the time of resection.

Clinical Implications: VI should be included in the pathological staging of resected lung cancer. Randomized trials of adjuvant chemo should be considered in those lung cancer patients with VI.

Joseph W Lewis Jr., MD(*); M Ajlouni, MD; R A Chapman, MD and C Stone, MD. Henry Ford Hospital, Detroit, MI.