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Observational Study
. 2022 Jul 8;48(3):e20210283.
doi: 10.36416/1806-3756/e20210283. eCollection 2022.

Impact of microvascular invasion on 5-year overall survival of resected non-small cell lung cancer

[Article in English, Portuguese]
Andreia Salarini Monteiro  1 , Sérgio Ricardo de Carvalho Araújo  2 , Luiz Henrique Araujo  3 , Mirian Carvalho de Souza  2
Affiliations
Observational Study

Impact of microvascular invasion on 5-year overall survival of resected non-small cell lung cancer

[Article in English, Portuguese]
Andreia Salarini Monteiro et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objectives: Non-small cell lung cancer (NSCLC) is an incidental and aggressive type of cancer. Although curative treatment can be offered, the recurrence rate is relatively high. Identifying factors that have a prognostic impact may guide changes in the staging system and recommendations for adjuvant therapy. The aim of this study was to evaluate the impact of microvascular invasion on the 5-year overall survival (OS) of patients with resected NSCLC treated at a reference cancer center.

Methods: This retrospective, observational cohort study included patients diagnosed with early-stage NSCLC (clinical stages I-IIIA), treated with curative-intent surgery at the Brazilian National Cancer Institute between 2010 and 2016.

Results: The dataset comprised 91 surgical patients, mostly females and white, with a mean age of 62 years (range between 29-83). Cases were distributed as stages I, II, and III in 55%, 29%, and 16%. Adenocarcinoma was the predominant histological subtype (67%), and microvascular invasion was present in 25% of the patients. The 5-year OS probability was 60% (95% CI, 48.3-68.9). Among all characteristics, advanced stages (p = 0.001) and the presence of microvascular invasion (p< 0.001) were related to a worse 5-year OS. After adjusting for age group and pathological stage, the presence of microvascular invasion was associated with a 4-fold increased risk of death (HR 3.9, 95% CI, 1.9-8.2).

Conclusion: The presence of microvascular invasion was an independent factor related to worse survival and, therefore, should be routinely assessed in resected specimens.

Objetivos:: O câncer de pulmão não pequenas células (CPNPC) é um tipo incidental e agressivo de câncer. Embora o tratamento curativo possa ser oferecido, a taxa de recidiva é relativamente alta. A identificação de fatores que têm impacto prognóstico pode orientar mudanças no TNM e recomendações para terapia adjuvante. O objetivo deste estudo foi avaliar o impacto da invasão microvascular na sobrevida global (SG) em 5 anos de pacientes com CPNPC ressecado tratados em um centro de referência em câncer.

Métodos:: Este estudo de coorte retrospectivo e observacional incluiu pacientes diagnosticados com CPNPC em estágio inicial (estágios clínicos I-IIIA), tratados com cirurgia com intenção curativa no Instituto Nacional de Câncer entre 2010 e 2016.

Resultados:: Foram incluídos 91 pacientes tratados com cirurgia, a maioria mulheres e brancos, com média de idade de 62 anos (variação entre 29-83). Os casos foram distribuídos em estágios I, II e IIIA em 55%, 29% e 16%. Adenocarcinoma foi o subtipo histológico predominante (67%), e a invasão microvascular esteve presente em 25% dos pacientes. A probabilidade de SG em 5 anos foi de 60% (IC 95%, 48,3-68,9). Dentre todas as características analisadas, estágios mais avançados (p = 0,001) e a presença de invasão microvascular (p < 0,001) foram relacionados a uma pior SG em 5 anos. Após ajustar para faixa etária e estágio patológico, a presença de invasão microvascular foi associada a um aumento de 4 vezes no risco de morte (RR 3,9, IC 95%, 1,9-8,2).

Conclusão:: A presença de invasão microvascular foi um fator independente relacionado a uma pior sobrevida e, portanto, deve ser avaliada rotineiramente em espécimes ressecados.

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Figures

Figure 1
Figure 1. Flow diagram of patient enrollment and analysis.
Figure 2
Figure 2. Overall survival probability curves of patients with non-small cell lung cancer treated surgically at INCA from 2010 to 2016, according to pathological stage.
Figure 3
Figure 3. Overall survival probability curves of patients with non-small cell lung cancer treated surgically at INCA from 2010 to 2016, according to the presence of microvascular invasion.
See this image and copyright information in PMC

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