Modification of pathologic T classification for non-small cell lung cancer with visceral pleural invasion: Data from 1,055 cases of cancers ≤ 3 cm Journal Article
| Authors: | Liang, R. B.; Li, P.; Li, B. T.; Jin, J. T.; Rusch, V. W.; Jones, D. R.; Wu, Y. L.; Liu, Q.; Yang, J.; Yang, M. Z.; Li, S.; Long, H.; Fu, J. H.; Zhang, L. J.; Lin, P.; Rong, T. H.; Hou, X.; Lin, S. X.; Yang, H. X. |
| Article Title: | Modification of pathologic T classification for non-small cell lung cancer with visceral pleural invasion: Data from 1,055 cases of cancers ≤ 3 cm |
| Abstract: | Background: Visceral pleural invasion (VPI) with PL1 or PL2 increases the T classification from T1 to T2 in non-small cell lung cancers (NSCLCs) ≤ 3 cm. We proposed a modified T classification based on VPI to guide adjuvant therapy. Research Question: Is it reasonable to upstage PL1-positive cases from T1 to T2 for NSCLCs ≤ 3 cm? Study Design and Methods: In total, 1,055 patients with resected NSCLC were retrospectively included. Tumor sections were restained with hematoxylin and eosin stain and Victoria blue elastic stain for the elastic layer. Disease-free survival (DFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Subgroup analysis and a Cox proportional hazards model were used to further determine the impact of VPI on survival. Results: The extent of VPI was diagnosed as PL0 in 824 patients, PL1 in 133 patients, and PL2 in 98 patients. The 5-year DFS rates of patients with PL0, PL1, and PL2 were 62.6%, 60.2%, and 28.8% (P < .01), whereas the corresponding 5-year OS rates were 78.6%, 74.4%, and 50.0% (P < .01), respectively. As predicted, the DFS and OS of patients with PL2 were much worse than those of patients with PL0 (P < .01) and PL1 (P < .01). However, both the DFS and OS of patients with PL0 and PL1 were comparable (DFS: P = .198; OS: P = .150). For node-negative cases, the DFS and OS of patients with PL0 and PL1 were also comparable (DFS: P = .468; OS: P = .388), but patients with PL2 had much worse DFS and OS than patients with PL0 (P < .01) and PL1 (P < .01). Multivariable analyses suggested that PL2, together with node positivity and poor cell differentiation, was an independent adverse prognostic factor. Interpretation: In NSCLCs ≤ 3 cm, tumors with PL1 should remain defined as T1, not T2. Overtreatment by adjuvant chemotherapy in node-negative NSCLCs ≤ 3 cm might be avoided in PL1 cases. © 2021 American College of Chest Physicians |
| Keywords: | adult; human tissue; aged; human cell; major clinical study; overall survival; cancer adjuvant therapy; comparative study; disease free survival; cancer staging; staging; tumor volume; cohort analysis; cell differentiation; retrospective study; staining; non-small cell lung cancer; pleura metastasis; non small cell lung cancer; visceral pleural invasion; cancer prognosis; prognosis; human; male; female; article; hematoxylin and eosin staining; victoria blue elastic staining |
| Journal Title: | Chest |
| Volume: | 160 |
| Issue: | 2 |
| ISSN: | 0012-3692 |
| Publisher: | American College of Chest Physicians |
| Date Published: | 2021-08-01 |
| Start Page: | 754 |
| End Page: | 764 |
| Language: | English |
| DOI: | 10.1016/j.chest.2021.03.022 |
| PUBMED: | 33745993 |
| PROVIDER: | scopus |
| PMCID: | PMC8449009 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2021 -- Source: Scopus |
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