Tumor Location Is a Significant Predictor of Lymphovascular Invasion in Patients With Small-sized Non-small Cell Lung...

Lymphovascular invasion is a well-established poor prognostic factor following limited resection in lung cancer patients. Therefore, predicting the presence of lymphovascular invasion based on clinical factors may facilitate the selection of the most appropriate surgical procedure. The aim of the present study was to identify preoperative predictive factors associated with pathological lymphovascular invasion.

A total of 248 primary lung cancer patients with cN0, computed tomography findings of ≤2.0 cm overall diameter, were included in this retrospective study. The presence of lymphovascular invasion was evaluated on a pathological basis, using resection specimens for factors of lymphatic and vascular invasions. Positive results for one or both factors were defined as positive for lymphovascular invasion. The diagnosis of lymphatic invasion was examined using immunostaining for D2-40. The presence of vascular invasion was evaluated using the elastic van Gieson staining method.

Univariate analysis indicated that the presence of a smoking history, a consolidation tumor ratio (CTR) >0.5, an elevated CYFRA, and a tumor in the hilar location were significant predictive factors for lymphovascular invasion. In multivariate analysis, the CTR >0.5, elevation of CYFRA, and tumor hilar location were independent predictive factors for lymphovascular invasion. A statistically significant correlation between tumor location and lymphovascular invasion was also observed in both the adenocarcinoma and squamous cell carcinoma subgroups.

Central lesions tended to exhibit higher frequency of lymphovascular invasion. Therefore, the expansion of limited resection for centrally located tumor lesions in small-sized NSCLC should be carefully considered.