Haemoptysis as a prognostic factor in lung adenocarcinoma after curative resection

Background: Haemoptysis is a common symptom of lung cancer. Its prognostic role and mechanisms are still poorly understood. Methods: We retrospectively reviewed 666 consecutive patients with primary lung adenocarcinoma who underwent complete resection. The prognostic value of haemoptysis with respect to overall survival (OS), disease-specific survival (DSS) and diseasefree survival (DFS) was analysed. To further explore the possible mechanisms of haemoptysis, we evaluated vascular endothelial growth factor (VEGF) expression, tumour necrosis, vascular invasion and extratumoural microvessel density (MVD) in 112 randomly selected patients. Results: Haemoptysis predicted poor OS, DSS and DFS in operable lung adenocarcinoma (all P < 0.001). In addition, haemoptysis was associated with high white blood cell (WBC) count (P = 0.032), high fibrinogen (Fib; P < 0.001), high tumour greatest dimension (P < 0.001), severe vascular invasion (P = 0.002) and central tumour location (P < 0.001). We obtained no statistically significant differences of VEGF expression, tumour necrosis and extratumoural MVD in haemoptysis and non-haemoptysis groups. Conclusion: Our study demonstrates that haemoptysis predicts poor OS, DSS and DFS in lung adenocarcinoma after curative resection. Vascular invasion rather than angiogenesis or tumour necrosis could be the most important mechanism of haemoptysis in lung adenocarcinoma.