Prognostic Impact of Lymphovascular Invasion in Resected Pathological Stage I Invasive Non-small Cell Lung Cancer: A
Lajie Man1, Xiaohu Hao1, Xiaolong Zhang1
1Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
Background:
Lymphovascular invasion (LVI) is a potential adverse prognostic factor in early-stage non-small-cell lung cancer (NSCLC), but its independent value in pathological stage I invasive carcinoma remains undefined.
Methods:
Patients with pathological stage I invasive NSCLC who underwent resection between 2011 and 2024 were identified from the West China Lung Cancer Database. Propensity score matching (1:2, caliper = 0.2 standard deviations of the estimated propensity score) balanced clinicopathological covariates. Survival outcomes (recurrence-free survival, overall survival, cancer-specific survival) were analyzed using Cox regression. Competing-risk models explored recurrence patterns.
Results:
Among 4622 included patients, 200 were LVI-positive and 4422 were LVI-negative. After matching (183 LVI-positive, 343 LVI-negative), LVI positivity was independently associated with worse recurrence-free survival (hazard ratio [HR] 1.91, P = 0.002), overall survival (HR 2.58, P = 0.003), and cancer-specific survival (HR 3.39, P = 0.002). LVI-positive patients had a higher risk of distant metastasis (HR 2.51, P < 0.001), whereas no significant difference was observed for local/regional recurrence (HR 1.43, P = 0.294).
Conclusions:
In resected pathological stage I invasive NSCLC, LVI is an independent adverse prognostic factor, driven predominantly by distant metastasis. The prognostic impact of LVI appeared more pronounced in patients without visceral pleural invasion. These findings support routine LVI reporting and risk-adapted postoperative surveillance.