Role of lymphatic invasion in the prognosis of patients with clinical node-negative and pathologic node-positive lung adenocarcinoma

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• 作者：Takahiro Mimae ; MD ; PhD^a ; Yasuhiro Tsutani ; MD ; PhD^a ; Yoshihiro Miyata ; MD ; PhD^a ; Tomoharu Yoshiya ; MD^a ; Yuta Ibuki ; MD^a ; Kei Kushitani ; MD ; PhD^b ; Yukio Takeshima ; MD ; PhD^b ; Haruhiko Nakayama ; MD ; PhD^c ; Sakae Okumura ; MD ; PhD^d ; Masahiro Yoshimura ; MD ; PhD^e ; Morihito Okada ; MD ; PhD^a ; ^{morihito1217@hiroshima-u.ac.jp" class="auth_mail}
• 关键词：10 ; 10.2 ; 10.4
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：June 2014
• 年：2014
• 卷：147
• 期：6
• 页码：1820-1826
• 全文大小：367 K

文摘

Some patients with clinical T1 N0 M0 lung adenocarcinoma have pathologic lymph node metastasis. However, neither the precise prognosis nor the factors predictive of the prognosis of such patients have yet been identified.

Methods

Our study included 609 patients with clinical T1 N0 M0 lung adenocarcinoma; 568 (93.3%) pathologic node negative [pN(–)] and 41 (6.7%) pathologic node positive [pN(+)] patients, diagnosed after complete surgical resection. The association between prognosis and pathologic findings was analyzed retrospectively.

Results

pN(+) patients had a significantly lower lepidic growth component ratio (10% vs 50%), a higher lymphatic invasion (LI) rate (68% vs 11%), vessel invasion rate (59% vs 14%), and visceral pleural invasion rate (29% vs 9%), compared with pN(–) patients (all Ps < .001). Surprisingly, 13 of 41 (32%) pN(+) patients showed no LI. In pN(–) patients, a multivariate analysis of recurrence-free survival revealed that lower lepidic growth component ratio, and lymphatic, vessel, and pleural invasion were significantly correlated with a poor prognosis (P = .008, .045, .031, and .024). However, in pN(+) patients, the multivariate analysis of recurrence-free survival showed that only LI was a significant independent prognostic factor (P = .037). The 5-year recurrence-free survival rates were as follows: 91.2% for pN(–)/LI(–) patients, 68.2% for pN(–)/LI(+) patients, 63.5% for pN(+)/LI(–) patients, and 41.9% for pN(+)/LI(+) patients. LI status stratified the prognosis not only in patients with no nodal metastasis but also in those with metastasis.

Conclusions

LI, which is not always present in node-positive adenocarcinoma, is an important prognostic variable in patients with node involvement.