BACKGROUND:Lung cancer is the leading cause of cancer death in the world. The objective of this study was to investigate the expression of vascular endothelial growth factors (VEGFs) and their receptors (VEGFRs) in patients with nonsmall cell lung cancer (NSCLC) and its correlation with the prognosis for patients with lung cancer.METHODS:The expression status of VEGFs and VEGFRs was examined in 48 nonconsecutive specimens of primary lung cancer by immunohistochemistry. Correlations between the expression of VEGFs and VEGFRs and clinicopathologic parameters were analyzed.RESULTS:Nineteen of 48 samples (39.6%) were moderately/highly immunoreactive for VEGF‐A, 6 samples (12.5%) were reactive for VEGF‐B, 14 samples (29.2%) were reactive for VEGF‐C, 11 samples (22.9%) were reactive for VEGF‐D, 20 samples (41.7%) were reactive for VEGFR1, 26 samples (54.2%) were reactive for VEGFR2, 20 samples (41.7%) were reactive for VEGFR3, and 19 samples (39.6%) were reactive for nuclear expression of VEGFR3. Patients with moderate/high VEGF‐C, VEGFR1, and VEGFR2 expression had worse survival, whereas patients with moderate/high VEGF‐D and nuclear VEGFR3 expression had better survival. After adjusting according to tumor stage, VEGF‐B and VEGF‐D expression had a significant correlation with worse survival in patients with stage I and II disease. Patients with stage III and IV disease who had VEGFR1 and VEGFR2 expression had worse survival, whereas the expression of VEGF‐D was correlated significantly with better survival. Finally, stage, VEGF‐D expression, and VEGFR1 expression were significantly independent prognostic predictors.CONCLUSIONS:The results of the current study indicated that the over‐expression of VEGFs and VEGFRs plays an important role in the survival of patients with NSCLC. The inclusion of angiogenic factors in the standard pathologic study of lung cancer may improve the clinical evaluation of patients with NSCLC. Cancer 2009. © 2009 American Cancer Society.

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Elevated VEGF serum levels have a negative prognostic impact on survival in NSCLC and early stages of lung cancer patients.

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We fully agree with Dr Guerini et al regarding how challenging the differentiation between lung toxicity and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with lung cancer (LC) can be. 1 However, we would like to comment on the management complexity of patients with LC (both for new tumor diagnoses and for known patients with cancer) during the COVID-19 pandemic beyond lung toxicity. There are few publications that address the clinical management of patients with LC in the current SARS-CoV-2 pandemic. [2][3][4][5] The clinical and radiologic manifestations of COVID-19 can mimic pulmonary toxicity or progression of tumor disease in patients with LC. 6 Some extrapulmonary complications of SARS-CoV-2 pneumonia may also simulate progression of cancer disease. 7 On the other hand, some treatment-related complications of patients with LC can radiologically mimic SARS-CoV-2 pneumonia. 8,9 Finally, the management of some diagnostic interventional procedures can be difficult in COVID-19 patients with LC. 10 In this letter, we describe our experience in the management of several patients with LC during the COVID-19 pandemic that affected our region, and which required close multidisciplinary collaboration between different specialists.