Lymphovascular invasion as a prognostic indicator in stage I non small cell lung cancer: A systematic review and meta analysis.

Abstract

7535 Background: Identification of pathologic features able to predict outcomes in resected stage I non-small cell lung cancer (NSCLC) may help to further stratify patients into risk groups, allowing for further refinement of adjuvant treatment recommendations. We performed a systematic review and meta-analysis to evaluate whether the presence of lymphovacular invasion (LVI) is associated with disease outcome in stage I NSCLC patients. Methods: A systematic search of the literature was performed (1990 to December 2012; Medline/Embase) using search terms related to lymphovascular invasion, lung cancer and prognosis. Studies were considered eligible if they reported the outcome of lung cancer in patients with LVI compared to those without. Pooled Hazard Ratios (HR) were estimated with a random effects model. Two different endpoints were independently analyzed: recurrence-free survival (RFS) and overall survival (OS). We analyzed both unadjusted and adjusted effect estimates, for a total of four separate meta-analyses. Several studies presented multiple results (i.e. adjusted and unadjusted and/or recurrence-free and overall survival) and were therefore included in more than one pooled analysis. Results: Of 2,878 titles identified, 20 articles met the inclusion criteria. Of these, 5 studies were excluded from the analysis due to duplication of results (n=4) and lack of data to calculate HR (n=1). The unadjusted models consisted of 808 (RFS) and 1675 (OS) patients, while the adjusted models consisted of 1,545 (RFS) and 2,601 (OS). The unadjusted pooled effect of LVI was significantly associated with worse both RFS (HR: 4.71, 95% Confidence Interval (CI): 3.08-7.21), and OS (HR: 3.05, 95% CI: 2.34-3.98). Adjusting for potential confounders yielded the same results with both RFS (HR: 2.49, 95% CI: 1.6-3.89), and OS (HR: 1.80, 95% CI: 1.44-2.25) being significantly worse for patients exhibiting LVI in their pathologic specimens. Conclusions: The present study indicates that LVI is an adverse prognostic factor in patients with surgically managed stage I lung cancer. Based on these results, the use of LVI as a stratifying factor in future prospective lung cancer trials seems to be justifiable.

Sublobar Resection in Stage IA Non–Small Cell Lung Cancer: Role of Preoperative CT Features in Predicting Pathologic Lymphovascular Invasion and Postoperative Recurrence

“…These CT features also predicted RFS, independent of clinical T category (T1b/T1c vs T1a) and surgical approach (segmentectomy vs wedge resection). pLVI is well-recognized as an important prognostic factor for NSCLC [1,7,9,10]. Yet, LVI is not incorporated in the current TNM staging system.…”

“…Lymphovascular invasion (LVI) is a high-risk pathologic feature in NSCLC and is significantly associated with both an increased risk of distant metastasis and shorter survival [7][8][9][10]. Some studies maintain that adjuvant chemotherapy is needed for patients with LVI, even in stage I disease [5,11].…”

High-Risk Factors for Recurrence of Stage I Lung Adenocarcinoma: Follow-up Data From JCOG0201

“…17,18 Some reports have regarded lymphatic permeation and vascular invasion as a single variable, termed lymphovascular invasion. 19,20 In those studies, lymphovascular invasion was a strong prognostic indicator for RFS and OS. There are some problems regarding making a diagnosis of vascular invasion differentiated from lymphatic permeation.…”