Clinical significance of lymphatic/vascular tumor cells (LVT) and adjuvant chemotherapy (AC) after curative resection of non-small cell lung cancer (NSCLC)

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7044 Background: AC after resection of NSCLC produce only a modest survival benefit. It is needed to find a group who will benefit from AC. Methods: Stage IB-IIIA NSCLC patients (pts) were randomized prospectively either as AC or control (C) group after curative surgery. The AC consisted of 4 cycles of cisplatin 60 mg/m2 (day 1, later changed to day 8) & vinorelbine 25 mg/m2 (day 1 & 8) q 4 weeks, which was started within 4 weeks after surgery (for stage IB) or immediately after postoperative radiotherapy (for stage II, IIIA, 50.4 Gy). C group did not receive AC except postoperative radiotherapy for the stage II, IIIA NSCLC. The end point was to see the disease free survival (DFS) and overall survival (OS) and to find a group who will benefit from AC. The prognostic factors including LVT with hematoxylin/eosin stain were analyzed using Kaplan-Meier plots & the log rank test. Results: From Feb. 2000 to Nov. 2004, 455 pts were enrolled. Gender, age, operative procedure, tumor size (≤ 5 v > 5 Cm), N stage, histology (squamous v non-squamous) and LVT in the pathologic specimen were well balanced between two groups (AC:227, C:228). Two hundred-one pts (44.2%) were stage IB, 150 pts (33.0%) were stage II, and 104 pts (22.8%) were stage IIIA. Ninety-four pts (20.7%) had LVT and the prevalence of LVT was 9% in stage IB, 19.3% in II and 45.2% in IIIA NSCLC. With the median follow up of 27.6 months, the 4-year DFS and OS in AC group and C group were 66.7 v 58.7% (p=0.148) and 67.8 v 61.1% (p=0.503). The log rank test showed that tumor size (> 5Cm), N2 disease, histology with non-squamous type and the presence of LVT were the poor prognostic factors for DFS. Tumor size (> 5Cm), N2 disease, and the presence of LVT were the poor prognostic factors for OS. In the subset analysis, the AC showed significant benefit of DFS (p=0.049) and OS (p=0.060) in the pts with LVT. But the AC could not influence on the DFS or OS of pts without LVT or with other poor prognostic factors. In contrast to other poor prognostic factors, LVT was not the poor prognostic factor for DFS in AC group. Conclusions: The presence of LVT in the surgical specimen is an important prognostic factor after resection of NSCLC and could be overcome by AC in the aspect of DFS and OS. No significant financial relationships to disclose.

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