1. ¹Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Belgium
2. ²Translational Cancer Research Group, Oncology Centre, General Hospital Sint-Augustinus and University of Antwerp, Antwerp, Belgium
3. ³Department of Pathology, University Hospital of Antwerp, Belgium
4. ⁴Cancer Research UK Tumour Pathology Group, Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, UK
5. ⁵Department of Epidemiology and Social Medicine, University Antwerp, Belgium

Correspondence: Dr P Sardari Nia, Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. E-mail: Peyman.Sardari.Nia@uza.be

Received 23 February 2004; Revised 28 June 2004; Accepted 16 July 2004; Published online 24 August 2004.

Abstract

An essential prerequisite of nonangiogenic growth appears to be the ability of the tumour to preserve the parenchymal structures of the host tissue. This morphological feature is visible on a routine tissue section. Based on this feature, we classified haematoxylin and eosin-stained tissue sections from 279 patients with non-small-cell lung cancer into three growth patterns: destructive (angiogenic; n=196), papillary (intermediate; n=38) and alveolar (nonangiogenic; n=45). A Cox multiple regression model was used to test the prognostic value of growth patterns together with other relevant clinicopathological factors. For overall survival, growth pattern (P=0.007), N-status (P=0.001), age (P=0.020) and type of operation (P=0.056) were independent prognostic factors. For disease-free survival, only growth pattern (P=0.007) and N-status (P<0.001) had an independent prognostic value. Alveolar (hazard ratio=1.825, 95% confidence interval=1.117–2.980, P=0.016) and papillary (hazard ratio=1.977, 95% confidence interval=1.169–3.345, P=0.011) growth patterns were independent predictors of poor prognosis. The proposed classification has an independent prognostic value for overall survival as well as for disease-free survival, providing a possible explanation for survival differences of patients in the same disease stage.