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Lymphovascular invasion is an independent predictor for shorter recurrence-free survival for patients with stage I NSCLC.
Lymphovascular invasion (LVI) has been shown to be a significant predictor associated with postoperative recurrence for patients with stage I NSCLC, according to Margaret Locke, MD.
“Lung cancer staging is not perfect—this is why new data to better risk stratify patients and improve future staging schemes is so important,” Dr. Locke says. “Our research found that patients with [LVI] on histology have worse outcomes for early-stage [NSCLCs]. However, the presence of [LVI] is not currently incorporated into staging criteria.”
Incorporating LVI into both staging and patient counseling may better risk stratify patients with these early-stage cancers, Dr. Locke explains. “Histological examination of the tissue specimen is usually done at the time of diagnosis and fairly inexpensive, which makes this finding more valuable,” she says.
Dr. Locke, Nagashree Seetharamu, MD, MBBS, and colleagues presented a study titled “High-Risk Histopathological Correlates of Stage I NSCLC Outcomes” at the recent 2023 North America Conference on Lung Cancer (NACLC) held in Chicago. “For risk stratification of early-stage lung cancer, LVI has proven to be a potent tool,” the study authors write.
The current International Association for the Study of Lung Cancer (IASLC-8th edition) for NSCLC staging upstages node negative, small tumors (≤3 cm) with visceral pleural invasion (VPI) to T2a that would otherwise have received T1a-T1c designation.
More than 7.0% of Patients Showed Eventual Recurrence at Follow-Up
Dr. Locke and team assessed the association between LVI, VPI, micropapillary pattern, and spread through airspaces (STAS) with patient outcomes for stage I NSCLC. They conducted a retrospective chart review on all patients with pathology confirming NSCLC who underwent lung resection at a single academic center. The study included patients (n=597; median age, 69.9; 62.3% women) with stage I node negative disease who were excluded if receiving neoadjuvant chemotherapy.
More than 7.0% of patients had eventual recurrence at follow-up, and median recurrence-free survival (RFS) was 88.2% at 3 years for all patients. Patient demographics were evaluated, including smoking history, Charlson Comorbidity Index, histopathological features (including STAS, VPI, LVI, and micropapillary pattern), staging, and dates of recurrence and death.
The Kaplan-Meier Method was utilized to estimate RFS. The association between histopathological features and patient outcomes was assessed via multivariate Cox proportional hazards regression.
LVI Is Independent Predictor for Shorter Recurrence-Free Survival
The study team observed that LVI is an independent predictor for shorter RFS (HR 3.071, P=0.0009; 95% CI, 1.503–5.711).
Although all of the histopathological features assessed are supported by research, their role as markers of poor prognosis, “VPI is the only feature currently used in staging, although in our study, it is not statistically significant,” Dr. Seetharamu writes, adding that similar to VPI, LVI may be useful in staging.
The study team agreed that further research is needed to establish whether LVI presence should require more aggressive treatment. “By improving risk stratification, our hope is that we can catch recurrence earlier and improve outcomes in these patients with early-stage cancers but high-risk features for recurrence and progression,” Dr. Locke says.
