Skip to main content

Advertisement

SpringerLink
Log in

Blood Vessel Invasion Predicts Postoperative Survival Outcomes and Systemic Recurrence Regardless of Location or Blood Vessel Type in Patients with Lung Adenocarcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Presence of blood vessel invasion (BVI) is one of the prognostic indicators for lung cancer patients with surgical resection. However, prognostic roles of the location and the type of the involved blood vessel have not been fully evaluated yet.

Patients and Methods

We retrieved the data of 217 cases of surgically resected lung adenocarcinoma from Asan Medical Center. Clinicopathologic features, including BVI, were reassessed. The location (tumor center and/or periphery) and involved blood vessel types (large and/or small vessels; arteries and/or veins) of BVI were separately examined on standard hematoxylin–eosin slides and confirmed by van Gieson elastic staining.

Results

BVI was identified in 35% of cases (76/217), with the tumor center (intratumoral) as the location in more than half of the cases (42/76, 55.3%). The presence of BVI was significantly associated with higher pathologic stage, increased size of invasive components, frequent pleural invasion, lymphatic permeation, and spread through alveolar spaces. BVI was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS) both in univariate and multivariate survival analyses [for OS, hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.06–3.48, P = 0.031; for RFS, HR 2.65, 95% CI 1.64–4.28; P < 0.001]. BVI subgroups, according to location and type of the involved blood vessels, invariably displayed significantly poor RFS; however, the results for OS varied.

Conclusion

Regardless of their location or blood vessel type, presence of BVI is a useful predictor for postoperative survival outcomes, which should be carefully evaluated on pathologic examination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34.

    Article  Google Scholar 

  2. Le Chevalier T. Adjuvant chemotherapy for resectable non-small-cell lung cancer: where is it going? Ann Oncol. 2010;21(7):196–8.

    Article  Google Scholar 

  3. David EA, Canter RJ, Chen Y, Cooke DT, Cress RD. Surgical management of advanced non-small cell lung cancer is decreasing but is associated with improved survival. Ann Thorac Surg. 2016;102:1101–9.

    Article  Google Scholar 

  4. Fedor D, Johnson WR, Singhal S. Local recurrence following lung cancer surgery: incidence, risk factors, and outcomes. Surg Oncol. 2013;22:156–61.

    Article  Google Scholar 

  5. Subotic D, Van Schil P, Grigoriu B. Optimising treatment for post-operative lung cancer recurrence. Eur Respir J. 2016;47:374–8.

    Article  CAS  Google Scholar 

  6. Amin MB, Edge S, Greene F, et al. (eds) AJCC cancer staging manual. 8th ed. New York: Springer; 2017.

    Book  Google Scholar 

  7. Higgins KA, Chino JP, Ready N, et al. Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy. J Thorac Oncol. 2012;7:1141–7.

    Article  Google Scholar 

  8. Yun JK, Lee GD, Choi S, et al. Comparison of prognostic impact of lymphovascular invasion in stage IA non-small cell lung cancer after lobectomy versus sublobar resection: a propensity score-matched analysis. Lung Cancer. 2020;146:105–11.

    Article  Google Scholar 

  9. Gabor S, Renner H, Popper H, et al. Invasion of blood vessels as significant prognostic factor in radically resected T1-3N0M0 non-small-cell lung cancer. Eur J Cardiothorac Surg. 2004;25:439–42.

    Article  CAS  Google Scholar 

  10. Kessler R, Gasser B, Massard G, et al. Blood vessel invasion is a major prognostic factor in resected non-small cell lung cancer. Ann Thorac Surg. 1996;62:1489–93.

    Article  CAS  Google Scholar 

  11. Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. Prognostic impact of intratumoral vascular invasion in non-small cell lung cancer patients. Thorax. 2010;65:1092–8.

    Article  Google Scholar 

  12. Miyoshi K, Moriyama S, Kunitomo T, Nawa S. Prognostic impact of intratumoral vessel invasion in completely resected pathologic stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137:429–34.

    Article  Google Scholar 

  13. Shoji F, Haro A, Yoshida T, et al. Prognostic significance of intratumoral blood vessel invasion in pathologic stage IA non-small cell lung cancer. Ann Thorac Surg. 2010;89:864–9.

    Article  Google Scholar 

  14. Shimada Y, Ishii G, Hishida T, Yoshida J, Nishimura M, Nagai K. Extratumoral vascular invasion is a significant prognostic indicator and a predicting factor of distant metastasis in non-small cell lung cancer. J Thorac Oncol. 2010;5:970–5.

    Article  Google Scholar 

  15. Azevedo AS, Follain G, Patthabhiraman S, Harlepp S, Goetz JG. Metastasis of circulating tumor cells: favorable soil or suitable biomechanics, or both? Cell Adh Migr. 2015;9:345–56.

    Article  CAS  Google Scholar 

  16. Usui S, Minami Y, Shiozawa T, et al. Differences in the prognostic implications of vascular invasion between lung adenocarcinoma and squamous cell carcinoma. Lung Cancer. 2013;82:407–12.

    Article  Google Scholar 

  17. Hashizume S, Nagayasu T, Hayashi T, et al. Accuracy and prognostic impact of a vessel invasion grading system for stage IA non-small cell lung cancer. Lung Cancer. 2009;65:363–70.

    Article  Google Scholar 

  18. Macchiarini P, Fontanini G, Hardin MJ, et al. Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-small-cell lung cancer. J Thorac Cardiovasc Surg. 1993;106:80–9.

    Article  CAS  Google Scholar 

  19. Okada S, Mizuguchi S, Izumi N, et al. Prognostic value of the frequency of vascular invasion in stage I non-small cell lung cancer. Gen Thorac Cardiovasc Surg. 2017;65:32–9.

    Article  Google Scholar 

  20. Turhan K, Samancilar O, Cagirici U, et al. The effect of blood vessel invasion on prognosis of operated stage I non-small cell lung cancer patients. Thorac Cardiovasc Surg. 2010;58:28–31.

    Article  CAS  Google Scholar 

  21. Samejima J, Yokose T, Ito H, et al. Prognostic significance of blood and lymphatic vessel invasion in pathological stage IA lung adenocarcinoma in the 8th edition of the TNM classification. Lung Cancer. 2019;137:144–8.

    Article  Google Scholar 

  22. Wang J, Chen J, Chen X, Wang B, Li K, Bi J. Blood vessel invasion as a strong independent prognostic indicator in non-small cell lung cancer: a systematic review and meta-analysis. PLoS One. 2011;6:e28844.

    Article  CAS  Google Scholar 

  23. National Comprehensive Cancer Network 2021. Non-small cell lung cancer (Version 2.2021). https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed December 30, 2020.

  24. Deryugina EI, Kiosses WB. Intratumoral cancer cell intravasation can occur independent of invasion into the adjacent stroma. Cell Rep. 2017;19:601–16.

    Article  CAS  Google Scholar 

  25. Stoletov K, Kato H, Zardouzian E, et al. Visualizing extravasation dynamics of metastatic tumor cells. J Cell Sci. 2010;123:2332–41.

    Article  CAS  Google Scholar 

  26. Noma D, Inamura K, Matsuura Y, et al. Prognostic effect of lymphovascular invasion on TNM staging in stage I non-small-cell lung cancer. Clin Lung Cancer. 2018;19:e109–22.

    Article  Google Scholar 

  27. Hamanaka R, Yokose T, Sakuma Y, et al. Prognostic impact of vascular invasion and standardization of its evaluation in stage I non-small cell lung cancer. Diagn Pathol. 2015;10:17.

    Article  Google Scholar 

Download references

Funding

The work is supported by the National Research Foundation of Korea (Grant No. 1711116429).

Author information

Authors and Affiliations

  1. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Goeun Lee MD, Bokyung Ahn MD, PhD, Se Jin Jang MD, PhD & Hee Sang Hwang MD, PhD

  2. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Shinkyo Yoon MD

  3. Department of Chest surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Hyeong-Ryul Kim MD, PhD

Authors
  1. Goeun Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinkyo Yoon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bokyung Ahn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyeong-Ryul Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Se Jin Jang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hee Sang Hwang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hee Sang Hwang MD, PhD.

Ethics declarations

DISCLOSURE

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 37 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, G., Yoon, S., Ahn, B. et al. Blood Vessel Invasion Predicts Postoperative Survival Outcomes and Systemic Recurrence Regardless of Location or Blood Vessel Type in Patients with Lung Adenocarcinoma. Ann Surg Oncol 28, 7279–7290 (2021). https://doi.org/10.1245/s10434-021-10122-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-10122-x

Search

Navigation