124 Chapter 10 In a total of 41 out of 70 patients (58.6%) intravascular tumor cells, tumor cell clusters and/or macrophages were found. These were also found in 8 of the 10 tumors without invasion (AIS) (80.0%) and in 33 of the 60 invasive tumors (55.0%; P =.18). No tumor cells were observed neither in venous nor in lymphatic vascular structures. Survival outcomes The median follow-up time in the pilot study was 58 months (range 1-112 months). The OS for intra-arterial tumor cells is shown in figure 2. In the exploratory cohort, the mean 5-year OS rate for the patients with intravascular tumor cells was 61% compared to 40% for the patients without intravascular tumor cells (P=.19). Figure 2. The Kaplan-Meier curves for overall survival in the pilot study are shown for tumor cells in lumen of the pulmonary arteries (P=.19). In the cohorts of the validation study, the median follow-up time was 61 months (range 11-113) for the Milan cases and 81 months (range 28-132) for the OLVG cases. In the Milan cohort, the 22 cases with intravascular tumor cells had a 5-years OS of 85.6% compared to 41.5% for the 13 cases without intravascular tumor cells (P=.002). In the OLVG cases, the 5-year OS for the 19 cases with and the 16 cases without intravascular tumor cells was 78.9% and 93.8%, respectively (P=.35). In both cohorts combined, the 5-years OS for cases with intravascular tumor cells was 82.5% versus 71.6% for cases without (P=.16) (Figure 3). The 5-years RFS data for both cohorts showed no significant differences, neither for the separate cohorts, nor combined (80.0% with and 80.9% without intravascular tumor cells; P=.52).
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