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David S. Ettinger, MD, FACP, FCCP


Is Vascular Pruning Associated With Poorer Clinical Outcomes in Early-Stage Lung Cancer?

By: Kayci Reyer
Posted: Thursday, May 26, 2022

There may be an association between the degree of aggression in vascular pruning and the risk for disease progression in patients with lung cancer, according to research presented at the American Thoracic Society (ATS) 2022 International Conference in San Francisco (Session D20). Tess Lichtman, MD, of Beth Israel Deaconess Medical Center, Boston, and colleagues quantified patients’ vascular pruning, or the disappearance of small pulmonary vessels, by analyzing CT imaging performed prior to surgical resection.

The study included 159 patients with early-stage lung adenocarcinoma who underwent wedge resection or lobectomy between 2005 and 2018. All patients experienced CT imaging prior to surgical intervention. Using three-dimensional reconstructions based on CT images plus an image analysis algorithm, the volumes of overall pulmonary vessels and small pulmonary vessels were calculated. An association was observed between more pronounced vascular pruning and an increased risk for disease progression. A 42% higher risk of disease progression (hazard ratio [HR] = 1.42; confidence interval [CI] = 1.00–2.02; P = .05) and a 65% higher risk of death (HR = 1.65; 95% CI = 1.18–2.30; P = .003) were associated with every standard deviation of a lower small blood vessel fraction, with lower fractions equaling a higher degree of pruning. The mean fraction of small pulmonary vessels was 45.5%.

At an average follow-up of 5.9 years, 42 patients (26.4%) experienced disease progression, and 49 patients (30.8%) died. The evaluated patient population was 59.1% female and had an average age of 69. A total of 36 patients (22.6%) were never-smokers, and 37 patients (23.3%) also had chronic obstructive pulmonary disease.

Disclosure: For full disclosures of the study authors, visit

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