Prognostic Significance of Vascular and Lymphatic Emboli in Resected Pulmonary Adenocarcinoma.

Background: The incidence of vascular and lymphatic emboli in a specimen of resected non-small cell lung cancer is variable according to different authors'' experience as well as prognostic significance in patients treated by surgery. We aimed at evaluating these factors in an unselected population of patients with primary pulmonary adenocarcinoma treated by major surgical resection. Methods: Clinical and pathology records of all patients treated by lobectomy or pneumonectomy and nodal dissection for pulmonary adenocarcinoma between June 2001 and June 2006 were retrospectively reviewed. Impact on survival of age, sex, tobacco use, history of chronic obstructive pulmonary disease, extent of resection, pathologic stage, and presence of vascular and lymphatic emboli was studied by univariate analysis and multivariate analysis (for factors significantly associated with survival at univariate analysis). Results: Five hundred three patients underwent lobectomy or pneumonectomy with nodal dissection for pathologically proven lung adenocarcinoma. There were 355 men and 148 women; mean age was 61.1 years, and 181 patients were 65 years old or older; 87% were current or former smokers; 90.3% had pulmonary lobectomy; and 9.7% had pneumonectomy. Pathologic stages were I, II, and III/IV in 45%, 17.9%, and 37.1%, respectively. Vascular emboli and lymphatic emboli were found in 183 of 503 patients (36.4%) and 149 of 503 (29.6%), respectively. Overall 5-year survival for the whole population was 50.7%. At univariate analysis, age more than 65 years (p = 0.0019), chronic obstructive pulmonary disease (p = 0.042), extent of resection (p = 0.047), pathologic stage (p < 0.0000001), T size (p = 0.0020), T and N variables (p = 0.0000016 and p < 0.0000001, respectively), presence of vascular emboli (p = 0.026), and presence of lymphatic emboli (p = 0.000021) were associated with worse prognosis. At multivariate analysis, age more than 65 years (p = 0.0047, relative risk 1.5), stage I versus II versus III versus IV (p = 0.00000032), and presence of lymphatic emboli (p = 0.05, relative risk 1.34) were identified as independent negative prognostic factors. Conclusions: In an unselected population of patients with pulmonary adenocarcinoma treated by lobectomy or pneumonectomy, the presence of lymphatic emboli is an independent negative prognostic factor. [Copyright &y& Elsevier]