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

Monteiro, Andreia Salarini; Araújo, Sérgio Ricardo de Carvalho; Araujo, Luiz Henrique; Souza, Mirian Carvalho de

doi:10.36416/1806-3756/e20210283

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ORIGINAL ARTICLE • J. bras. pneumol. 48 (03) • 2022 • https://doi.org/10.36416/1806-3756/e20210283 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Keywords:
non-small cell lung cancer; thoracic surgery; survival analysis; microvascular invasion.

Characteristics	Microvascular invasion				Total
	Absent		Present		p-value
	N	%	N	%		N	%
Total	68	74.7	23	25.3	-	91	100.0
Age group
< 60 years	22	32.4	10	43.5	0.334	32	35.2
≥ 60 years	46	67.6	13	56.5		59	64.8
Sex
Male	30	44.1	10	43.5	0.957	40	44.0
Female	38	55.9	13	56.5		51	56.0
Race
White	41	60.3	16	69.6	0.427	57	62.6
Non-white	27	39.7	7	30.4		34	37.4
Smoking status
Never smoked	11	16.2	3	13.0	0.500	14	15.4
Current or former smoker	57	83.8	20	87.0		77	84.6
Smoking load
< 40 pack-years	18	31.6	5	25.0	0.898	23	29.9
40-59 pack-years	17	29.8	7	35.0		24	31.2
≥ 60 pack-years	22	38.6	8	40.0		30	39.0
Performance Status (PS)
0	27	39.7	6	26.1	0.240	33	36.3
1	41	60.3	17	73.9		58	63.7
Maximum SUV
< 10	38	64.4	8	40.0	0.056	46	58.2
≥ 10	21	35.6	12	60.0		33	41.8
Tumor size
pT1	21	30.9	4	17.4	0.157	25	27.5
pT2	37	54.4	11	47.8		48	52.7
pT3	8	11.8	6	26.1		14	15.4
pT4	2	2.9	2	8.7		4	4.4
pN
pN0	61	89.7	12	52.2	< 0.001	73	80.2
pN1	2	2.9	8	34.8		10	11.0
pN2	5	7.4	3	13.0		8	8.8
Pathological stage
IA	21	30.9	2	8.7	0.003	23	25.3
IB	24	35.3	3	13.0		27	29.7
IIA	8	11.8	7	30.4		15	16.5
IIB	8	11.8	3	13.0		11	12.1
IIIA	7	10.3	8	34.8		15	16.5
Histological subtype
Adenocarcinoma	46	67.6	15	65.2	0.191	61	67.0
Squamous cell carcinoma	20	29.4	5	21.7		25	27.5
Other	2	2.9	3	13.0		5	5.5

Characteristics	5-y OS	CI_95%	log-rank p-value
Global	59.4	(48.3-68.9)	n.a.
Age group
< 60 years	67.8	(48.1-81.3)	0.211
≥ 60 years	54.9	(41.1-66.8)
Sex
Male	59.4	(42.4-72.9)	0.683
Female	59.5	(44.3-71.8)
Race
White	62.6	(48.5-73.8)	0.618
Non-white	53.9	(35.2-69.4)
Smoking status
Never smoked	64.3	(34.3-83.3)	0.997
Current or former smoker	58.7	(46.6-68.9)
Smoking load
< 40 pack-years	69.3	(46.1-84.0)	0.456
40-59 pack-years	47.1	(25.5-66.1)
≥ 60 pack-years	59.1	(39.2-74.4)
Performance Status (PS)
0	69.3	(50.3-82.2)	0.188
1	53.8	(39.7-65.9)
Maximum SUV
< 10	62.9	(46.3-75.6)	0.588
≥ 10	60.6	(42.0-74.9)
Tumor size
pT1	59.4	(37.6-75.8)	0.093
pT2	67.4	(51.6-79.0)
pT3	42.9	(17.7-66.0)
pN
pN0	67.5	(55.1-77.1)	0.001
pN1	15.0	(1.0-45.7)
pN2	37.5	(8.7-67.4)
Pathological stage
I	68.9	(53.5-80.0)	0.001
II	61.0	(39.6-76.9)
IIIA	25.0	(6.9-48.8)
Histological subtype
Adenocarcinoma	61.3	(47.5-72.4)	0.878
Squamous cell carcinoma	58.6	(36.6-75.3)
Microvascular invasion
Absent	70.8	(58.0-80.4)	< 0.001
Present	26.1	(10.6-44.7)

Characteristics	Hazard Ratio (HR)
	Crude			Adjusted
	HR	CI_95%	p-value	HR	CI_95%	p-value
Age group
< 60 years	1.0			1.0
≥ 60 years	1.6	(0.8-3.3)	0.217	1.9	(0.9-3.9)	0.101
Pathological stage
I	1.0			1.0
II	1.3	(0.6-2.9)	0.521	0.8	(0.3-1.8)	0.555
IIIA	4.0	(1.8-8.8)	0.001	2.8	(1.2-6.5)	0.017
Microvascular invasion
Absent	1.0			1.0
Present	3.7	(1.9-7.1)	< 0.001	3.9	(1.9-8.2)	< 0.001

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[1] Correspondence to:
Luiz H. Araujo. Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37, 5º andar, prédio anexo, Centro, CEP 20231-050, Rio de Janeiro, RJ, Brasil. Tel.: 55 21 3207-6650. Fax: 55 21 3207-6566. E-mail: luiz.lima@inca.gov.br