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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 80-89, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
P Macchiarini, G Fontanini, MJ Hardin, H Chuanchieh, D Bigini, S Vignati, R Pingitore and CA Angeletti
The prognostic significance of traditional and newer tumor cell-related
biologic parameters, like deoxyribonucleic acid ploidy (flow cytometry),
proliferative activity (expression of proliferating cell nuclear antigen by
immunohistochemistry), mitotic count, and intratumoral or peritumoral (or
both) blood or lymphatic vessel invasion by tumor cells was investigated in
95 consecutive patients who had T1 N0 M0 non-small-cell lung cancer and who
had operation alone between 1975 and 1985. The median follow-up for the
entire group is now 8.3 years, and overall 5-, 10-, and 15-year-survivals
were 75%, 69%, and 61%, respectively. Twenty-two patients died of either
local (n = 3) or systemic (n = 19) recurrent non-small-cell lung cancer, 5
of non- cancer-related causes, 2 of new primary lung cancer, and 1 of an
extrathoracic cancer. By multivariate analysis, blood vessel invasion by
tumor cells (p = 0.0001) and mitotic count (p = 0.016) were independent
predictors of survival; by contrast, the disease-free survival was
influenced only by blood vessel invasion (p = 0.0004). The relative risk of
death of recurrent non-small-cell lung cancer for low- risk patients (n =
79) was 13.3 (95% confidence interval, 6.1 to 28.7) times lower than that
of high-risk patients (n = 16) (p < 0.0001). The relative risk of
manifesting recurrent disease as distant metastasis for high-risk patients
was 25.64 (95% confidence intervals, 8.4 to 77.6) times higher than that of
their low-risk counterparts (p < 0.0001). These results provide a
rationale for effective systemic adjuvant treatment in completely resected
T1 N0 M0 non-small-cell lung cancer tailored to the individual patients'
risk of development of recurrent non-small-cell lung cancer.
ARTICLES
Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-small-cell lung cancer
Service of Thoracic Surgery, University of Pisa, Italy.
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