Arterial Invasion Predicts Early Mortality in Stage I Non–Small Cell Lung Cancer

Background A retrospective study was performed to evaluate the association between arterial invasion and survival in patients with stage I non–small cell lung cancer. Methods One hundred patients were identified who had undergone complete anatomic resection as definitive treatment for stage I non–small cell lung cancer. The tumors were reviewed for the presence or absence of arterial invasion. Five-year survival data were obtained for all patients. Results The 100 patients had an overall 5-year survival of 61%. There were 64 stage IA patients with a 62% 5-year survival and 36 stage IB patients with a 58% 5-year survival. The 39 patients identified with arterial invasion had a 38% 5-year survival compared with a 73% 5-year survival in the 61 patients without arterial invasion (p< 0.001), with an unadjusted hazard ratio of 3.5 (p< 0.001). Multivariate analysis by stage IA versus IB and by size greater or less than 2 cm demonstrated hazard ratios of 3.5 and 4.0, respectively (p< 0.001). This difference was independent of demographic characteristics, tumor type, or grade. Subgroup analysis revealed a hazard ratio of 5.8 in patients with stage IA non–small cell lung cancer (p< 0.001) and 19.8 in patients with tumors ≤ 2 cm (p = 0.006). Conclusions Arterial invasion is present in a substantial percentage of patients with stage I non–small cell lung cancer and is adversely associated with survival.