Lymphovascular Invasion is a Predictor of Postoperative Recurrence or Death in Stage I Non-small-cell Lung Cancer (NSCLC).

BACKGROUND

Histopathological features can be valuable prognostic tools in risk stratification of early-stage nonsmall cell lung cancers (NSCLC). This study evaluates the correlation between lymphovascular invasion (LVI), visceral pleural invasion (VPI), micropapillary pattern, and spread through airspaces (STAS) with outcomes in stage I NSCLC.

METHODS

Retrospective chart review was conducted on patients who underwent lung resection at a single academic center between 2015 and 2019 with pathology confirming NSCLC. Patients treated with neoadjuvant chemotherapy or with stage II or above cancers were excluded. Records were reviewed for demographics, histopathological features, Charlson comorbidity index (CCI), TNM staging (IASLC 8th edition), recurrence, and death. Recurrence free survival (RFS) was estimated via Kaplan-Meier Method. Correlation between STAS, VPI, LVI, micropapillary pattern, and patient outcomes was examined via multivariate Cox proportional hazards regression models.

RESULTS

A total of 596 patients were included in the analysis. Median follow-up was 35.3 months. Median RFS at 3 years was 88.4%. In multivariate analysis, LVI was an independent predictor for shorter RFS (HR = 4.19; 95% CI, 1.85-9.47; P < .001). Age > 75 and receipt of adjuvant chemotherapy were also found to be independent poor prognosticators. STAS, VPI, and micropapillary pattern had nonsignificant associations with RFS. A significant interaction was noted between LVI and adjuvant chemotherapy suggesting lower risk of recurrence (HR = 0.12; 95% CI, 0.02-0.74; P = .022).

CONCLUSIONS

LVI was a strong independent predictor associated with postoperative recurrence. Adjuvant chemotherapy, while associated with poor prognosis overall, seemed to decrease the risk of recurrence in patients whose tumors had LVI.