Prognostic Signifcance of Visceral Pleural Invasion in 3-5 cm Non-small Cell Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGHai-tao , ZHANGZhen-rong , FENGHong-xiang , GUOYong-qing , SHIBin , SONGZhi-yi , TIANYanchu , LIANGChao-yang ,  LIUDe-ruo

Department of Toracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P. R. China;

Corresponding author：

LIUDe-ruo, Email: deruoliu@vip.sina.com

Keywords：

Non-small cell lung cancer; Prognosis; Visceral pleural invasion

DOI：

10.7507/1007-4848.20150277

Video：

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Objective To evaluate the prognostic significance of visceral pleural invasion in diameter 3-5 cm nonsmall cell lung cancer(NSCLC). Methods A total of 112 patients who underwent lobectomy and pathologically diagnosed with NSCLC(3-5 cm) were included in our hospital between January 2006 and December 2010.There were 72 males and 40 females at average age of 61(28-72) years. There were 62 patients diagnosed as adenocarcinoma and 44 as squamous cell lung cancer. Viceral pleural invasion(VPI) was identified in 63 patients as a VPI group. The other 49 patients without VPI were as a NVPI group. All patients were performed with lobectomy and mediastinal lymph node dissection. Results There was no perioperative mortality. More smokers were included in the VPI group when compared with the NVPI group(53.9% vs. 28.6%, P=0.007). More squamous cell cancers were included in the VPI group, while more adenocarcinoma were included in the NVPI group with a statistical difference(P=0.003). The average follow-up duration was 52 months. A total of 32 death occurred at the endpoint. The overall survival(OS) of all included patients was 71.4%. The average follow-up duration was 51 months in the VPI group and 54 months in the NVPI group(P=0.441). There was no statistical difference in OS between the VPI group and the NVPI group(61.7% vs. 83.7%, P=0.017). Cox regression showed age less than 65 years(P=0.007), TNM stage(P=0.013), and VPI(P=0.035) were significant prognostic factors for NSCLC. Conclusion We identified the presence of VPI as an independent poor prognostic factor in NSCLC patients with diameter at 3-5 cm.

Citation： ZHANGHai-tao, ZHANGZhen-rong, FENGHong-xiang, GUOYong-qing, SHIBin, SONGZhi-yi, TIANYanchu, LIANGChao-yang, LIUDe-ruo. Prognostic Signifcance of Visceral Pleural Invasion in 3-5 cm Non-small Cell Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(12): 1109-1113. doi: 10.7507/1007-4848.20150277 Copy

1.	Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2005, 130(1):160-165.
2.	Manac'h D, Riquet M, Medioni J, et al. Visceral pleura invasion by non-small cell lung cancer:an underrated bad prognostic factor. Ann Thorac Surg, 2001, 71(4):1088-1093.
3.	David E, Thall PF, Kalhor N, et al. Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size. Ann Thorac Surg, 2013, 95(6):1872-1877.
4.	Brewer LA, Bai AF, Little JN, et al. Carcinoma of the lung; practical classification for early diagnosis and surgical treatment. J Am Med Assoc, 1958, 166(10):1149-1155.
5.	Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6):1710-1717.
6.	Takizawa T, Terashima M, Koiki T, et al. Lymph node metastasis in small peripheral adenocarcinoma of the lung. J Thorac Cardiovasc Surg, 1998, 116(2):276-280.
7.	Nitadori J, Colovos C, Kadota K, et al. Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm:a proposal to reclassify T1 lung adenocarcinoma. Chest, 2013, 144(5):1622-1631.
8.	Fibla JJ, Cassivi SD, Brunelli A, et al. Re-evaluation of the prognostic value of visceral pleura invasion in Stage IB non-small cell lung cancer using the prospective multicenter ACOSOG Z0030 trial data set. Lung Cancer, 2012, 78(3):259-262.
9.	Koike T, Koike T, Yoshiya K, et al. Risk factor analysis of locoregional recurrence after sublobar resection in patients with clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2013, 146(2):372-378.
10.	David E, Thall PF, Kalhor N, et al. Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size. Ann Thorac Surg, 2013, 95(6):1872-1877.
11.	Hung JJ, Jeng WJ, Chou TY, et al. Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification on death and recurrence in completely resected stage I lung adenocarcinoma. Ann Surg, 2013, 258(6):1079-1086.
12.	Kawase A, Yoshida J, Miyaoka E, et al. Visceral pleural invasion classification in non-small cell lung cancer in the 7th edition of the tumor, node, metastasis classification for lung cancer:validation analysis based on a large-scale nationwide database. J Thorac Oncol, 2013, 8(5):606-611.
13.	Yanagawa N, Shiono S, Abiko M, et al. Prognostic impact and initial recurrence site of lymphovascular and visceral pleural invasion in surgically resected stage I non-small-cell lung carcinoma. Euro J Cardio-Thorac Surg, 2013, 44(3):e200-206.
14.	Dignam JJ, Zhang Q, Kocherginsky M. The use and interpretation of competing risks regression models. Clin Cancer Res, 2012, 18(8):2301-2308.
15.	Maeda R, Yoshida J, Ishii G, et al. Influence of cigarette smoking on survival and tumor invasiveness in clinical stage IA lung adenocarcinoma. Ann Thorac Surg, 2012, 93(5):1626-1632.
16.	Kudo Y, Saji H, Shimada Y, et al. Impact of visceral pleural invasion on the survival of patients with non-small cell lung cancer. Lung Cancer, 2012, 78(2):153-160.
17.	Butnor KJ, Travis WD. Recent advances in our understanding of lung cancer visceral pleural invasion and other forms of minimal invasion:implications for the next TNM classification. Eur J Cardiothorac Surg, 2013, 43(2):309-311.
18.	Chang YL, Lin MW, Shih JY, et al. The significance of visceral pleural surface invasion in 321 cases of non-small cell lung cancers with pleural retraction. Ann Surg Oncol, 2012, 19(9):3057-3064.
19.	Tao H, Hayashi T, Sano F, et al. Prognostic impact of lymphovascular invasion compared with that of visceral pleural invasion in patients with pN0 non-small-cell lung cancer and a tumor diameter of 2 cm or smaller. J Surg Res, 2013, 185(1):250-254.
20.	Kawase A, Yoshida J, Miyaoka E, et al. Visceral pleural invasion classification in non-small-cell lung cancer in the 7th edition of the tumor, node, metastasis classification for lung cancer:validation analysis based on a large-scale nationwide database. J Thorac Oncol, 2013, 8(5):606-611.
21.	Light RW, Lee YC. Textbook of Pleural Diseases. 3rd ed. London:Arnold Publishers, 2003.
22.	Riquet M, Badoual C, Le Pimpec Barthes F, et al. Visceral pleura invasion and pleural lavage tumor cytology by lung cancer:a prospective appraisal. Ann Thorac Surg, 2003, 75(2):353-355.
23.	Wang NS. The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura. Am Rev Respir Dis, 1975, 111(1):12-20.
24.	Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion classification in non-small cell lung cancer:a proposal on the basis of outcome assessment. J Thorac Cardiovasc Surg, 2004, 127(6):1574-1578.
25.	Seok Y, Yang HC, Kim TJ, et al. Frequency of lymph node metastasis according to the size of tumors in resected pulmonary adenocarcinoma with a size of 30 mm or smaller. J Thorac Oncol, 2014, 9(6):818-824.

1. Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2005, 130(1):160-165.
2. Manac'h D, Riquet M, Medioni J, et al. Visceral pleura invasion by non-small cell lung cancer:an underrated bad prognostic factor. Ann Thorac Surg, 2001, 71(4):1088-1093.
3. David E, Thall PF, Kalhor N, et al. Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size. Ann Thorac Surg, 2013, 95(6):1872-1877.
4. Brewer LA, Bai AF, Little JN, et al. Carcinoma of the lung; practical classification for early diagnosis and surgical treatment. J Am Med Assoc, 1958, 166(10):1149-1155.
5. Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6):1710-1717.
6. Takizawa T, Terashima M, Koiki T, et al. Lymph node metastasis in small peripheral adenocarcinoma of the lung. J Thorac Cardiovasc Surg, 1998, 116(2):276-280.
7. Nitadori J, Colovos C, Kadota K, et al. Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm:a proposal to reclassify T1 lung adenocarcinoma. Chest, 2013, 144(5):1622-1631.
8. Fibla JJ, Cassivi SD, Brunelli A, et al. Re-evaluation of the prognostic value of visceral pleura invasion in Stage IB non-small cell lung cancer using the prospective multicenter ACOSOG Z0030 trial data set. Lung Cancer, 2012, 78(3):259-262.
9. Koike T, Koike T, Yoshiya K, et al. Risk factor analysis of locoregional recurrence after sublobar resection in patients with clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2013, 146(2):372-378.
10. David E, Thall PF, Kalhor N, et al. Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size. Ann Thorac Surg, 2013, 95(6):1872-1877.
11. Hung JJ, Jeng WJ, Chou TY, et al. Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification on death and recurrence in completely resected stage I lung adenocarcinoma. Ann Surg, 2013, 258(6):1079-1086.
12. Kawase A, Yoshida J, Miyaoka E, et al. Visceral pleural invasion classification in non-small cell lung cancer in the 7th edition of the tumor, node, metastasis classification for lung cancer:validation analysis based on a large-scale nationwide database. J Thorac Oncol, 2013, 8(5):606-611.
13. Yanagawa N, Shiono S, Abiko M, et al. Prognostic impact and initial recurrence site of lymphovascular and visceral pleural invasion in surgically resected stage I non-small-cell lung carcinoma. Euro J Cardio-Thorac Surg, 2013, 44(3):e200-206.
14. Dignam JJ, Zhang Q, Kocherginsky M. The use and interpretation of competing risks regression models. Clin Cancer Res, 2012, 18(8):2301-2308.
15. Maeda R, Yoshida J, Ishii G, et al. Influence of cigarette smoking on survival and tumor invasiveness in clinical stage IA lung adenocarcinoma. Ann Thorac Surg, 2012, 93(5):1626-1632.
16. Kudo Y, Saji H, Shimada Y, et al. Impact of visceral pleural invasion on the survival of patients with non-small cell lung cancer. Lung Cancer, 2012, 78(2):153-160.
17. Butnor KJ, Travis WD. Recent advances in our understanding of lung cancer visceral pleural invasion and other forms of minimal invasion:implications for the next TNM classification. Eur J Cardiothorac Surg, 2013, 43(2):309-311.
18. Chang YL, Lin MW, Shih JY, et al. The significance of visceral pleural surface invasion in 321 cases of non-small cell lung cancers with pleural retraction. Ann Surg Oncol, 2012, 19(9):3057-3064.
19. Tao H, Hayashi T, Sano F, et al. Prognostic impact of lymphovascular invasion compared with that of visceral pleural invasion in patients with pN0 non-small-cell lung cancer and a tumor diameter of 2 cm or smaller. J Surg Res, 2013, 185(1):250-254.
20. Kawase A, Yoshida J, Miyaoka E, et al. Visceral pleural invasion classification in non-small-cell lung cancer in the 7th edition of the tumor, node, metastasis classification for lung cancer:validation analysis based on a large-scale nationwide database. J Thorac Oncol, 2013, 8(5):606-611.
21. Light RW, Lee YC. Textbook of Pleural Diseases. 3rd ed. London:Arnold Publishers, 2003.
22. Riquet M, Badoual C, Le Pimpec Barthes F, et al. Visceral pleura invasion and pleural lavage tumor cytology by lung cancer:a prospective appraisal. Ann Thorac Surg, 2003, 75(2):353-355.
23. Wang NS. The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura. Am Rev Respir Dis, 1975, 111(1):12-20.
24. Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion classification in non-small cell lung cancer:a proposal on the basis of outcome assessment. J Thorac Cardiovasc Surg, 2004, 127(6):1574-1578.
25. Seok Y, Yang HC, Kim TJ, et al. Frequency of lymph node metastasis according to the size of tumors in resected pulmonary adenocarcinoma with a size of 30 mm or smaller. J Thorac Oncol, 2014, 9(6):818-824.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic Signifcance of Visceral Pleural Invasion in 3-5 cm Non-small Cell Lung Cancer

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