Prognostic relevance of angiogenesis in stage III NSCLC receiving multimodality treatment

¹ Dept of Thoracic Oncology, Thoraxklinik at the University of Heidelberg; and Dept of Medicine, Hematology/Oncology, University of Muenster
² Dept of Medicine, Hematology/Oncology, University of Muenster
³ Dept of Thoracic Oncology, Thoraxklinik at the University of Heidelberg
⁴ Institute of Pathology, Klinikum Bremen-Mitte
⁵ Dept of Medical Informatics and Biomathematics, University of Muenster, Germany

^* To whom correspondence should be addressed. E-mail: michael.kreuter{at}thoraxklinik-heidelberg.de.

	Abstract

Compelling evidence indicates that microvessel density (MVD) is a prognostic marker in early non-small cell lung cancer (NSCLC). However, its role in lymph node metastases (LN) in stage III NSCLC receiving multimodality treatment is unknown.

LN of 142 patients with stage III NSCLC treated in a trial of the German Lung Cancer Cooperative group, were evaluated for MVD. Median follow-up was 7.39 years. MVD was correlated with demographic and tumour-related variables and survival.

MVD (median 33.9) did not correlate with survival. Though, in multimodality treated stage IIIA patients receiving tumour resection with negative margins (R0), those with a high MVD had significantly prolonged overall survival with a median of 4.96 years compared to 1.99 years for those with low MVD (p=0.041). Cox regression analysis revealed that MVD was a prognostic factor in R0-resected stage IIIA (hazard ratio 0.417). Furthermore, a significant correlation of MVD to stage was observed with significant lower MVD in stage IIIA than IIIB (p=0.0062) and to histological subtype with adenocarcinoma revealing the highest scores (p=0.0001).

Increased angiogenesis within LN is a prognostic indicator for better survival in NSCLC patients. Thus, measurement of MVD might be useful in selecting patients for future neoadjuvant treatment decisions.