PROGNOSTIC-SIGNIFICANCE OF PERITUMOURAL BLOOD AND LYMPHATIC VESSEL INVASION BY TUMOR-CELLS IN T4 NONSMALL CELL LUNG-CANCER FOLLOWING INDUCTION THERAPY

We investigated the impact of new biological prognostic factors in 28 patients receiving a median of two courses of cisplatin-based chemothe rapy with (n = 14) or without (n = 14) radiation and operation for sta ge IIIB (T4) non-small cell lung cancer (NSCLC). After induction thera py, 5 patients had a complete and 21 a partial response; 2 had a stabl e disease. A complete resection was made in 26 patients (93%). Five pa tients (18%) had their primary tumour and involved vestiges completely sterilized. In the remaining 23, the majority of the tumours showed a bnormalities in the p53 gene expression (56%), harboured proliferating cells (91%) and induced angiogenesis (91%). Peritumoural blood and ly mphatic vessel invasion (PBLVI) by tumour emboli was observed in 6 tum ours. With a median follow-up of 25 months, overall 3-year survival wa s 48%; disease-free survival (DFS) has not been reached yet. The only significant factor influencing DFS in multivariate analysis was PBLVI by tumour cells; PBLVI-positive patients had a significantly higher li kelihood ratio (P = 0.000001) of developing metastasis than their PBLV I-negative counterparts. This study documents the prognostic implicati on of PBLVI by tumour cells in T4 NSCLC.