BLOOD-VESSEL INVASION BY TUMOR-CELLS PREDICTS RECURRENCE IN COMPLETELY RESECTED T1-N0-M0 NON-SMALL-CELL LUNG-CANCER

The prognostic significance of traditional and newer tumor cell-relate d biologic parameters, like deoxyribonucleic acid ploidy (flow cytomet ry), proliferative activity (expression of proliferating cell nuclear antigen by immunohistochemistry), mitotic count, and intratumoral or p eritumoral (or both) blood or lymphatic vessel invasion by tumor cells was investigated in 95 consecutive patients who had T1 NO MO non-smal l-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 overal l 5-, 10-, and 15-year-survivals were 75 %, 69 %, and 61 %, respective ly. Twenty-two patients died of either local (n = 3) or systemic (n = 19) recurrent non-small-cell lung cancer, 5 of non-cancer-related caus es, 2 of new primary lung cancer, and 1 of an extrathoracic cancer. By multivariate analysis, blood vessel invasion by tumor cells (p = 0.00 01) and mitotic count (p = 0.016) were independent predictors of survi val; by contrast, the disease-free survival was influenced only by blo od vessel invasion (p = 0.0004). The relative risk of death of recurre nt 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 rati onale for effective systemic adjuvant treatment in completely resected T1 N0 M0 non-small-cell lung cancer tailored to the individual patien ts' risk of development of recurrent non-small-cell lung cancer.