An essential prerequisite of nonangiogenic growth appears to be the ability of the tumour to preserve the parenchymal structures of the host tissue. This morphological feature is visible on a routine tissue section. Based on this feature, we classified haematoxylin and eosin-stained tissue sections from 279 patients with non-small-cell lung cancer into three growth patterns: destructive (angiogenic; n ¼ 196), papillary (intermediate; n ¼ 38) and alveolar (nonangiogenic; n ¼ 45). A Cox multiple regression model was used to test the prognostic value of growth patterns together with other relevant clinicopathological factors. For overall survival, growth pattern (P ¼ 0.007), N-status (P ¼ 0.001), age (P ¼ 0.020) and type of operation (P ¼ 0.056) were independent prognostic factors. For disease-free survival, only growth pattern (P ¼ 0.007) and N-status (Po0.001) had an independent prognostic value. Alveolar (hazard ratio ¼ 1.825, 95% confidence interval ¼ 1.117 -2.980, P ¼ 0.016) and papillary (hazard ratio ¼ 1.977, 95% confidence interval ¼ 1.169 -3.345, P ¼ 0.011) growth patterns were independent predictors of poor prognosis. The proposed classification has an independent prognostic value for overall survival as well as for disease-free survival, providing a possible explanation for survival differences of patients in the same disease stage.
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