Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm: A proposal to reclassify T1 lung adenocarcinoma Journal Article

   

Authors:	Nitadori, J. I.; Colovos, C.; Kadota, K.; Sima, C. S.; Sarkaria, I. S.; Rizk, N. P.; Rusch, V. W.; Travis, W. D.; Adusumilli, P. S.
Article Title:	Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm: A proposal to reclassify T1 lung adenocarcinoma
Abstract:	Background: T1 (≤ 3 cm) tumors with visceral pleural invasion (VPI) are upstaged to T2a (stage IB) in the TNM classification. We investigated the effect of VPI on the cumulative incidence of recurrence (CIR) and overall survival (OS) of lung adenocarcinoma (ADC) ≤2 cm (T1a) and 2 to 3 cm (T1b). Methods: OS and CIR among patients with or without VPI were examined by tumor size (≤ 2 and 2-3 cm) in 777 patients with node-negative lung ADC ≤ 3 cm who underwent resection. Results: Among patients with tumors ≤ 2 cm, VPI was not associated with either increased CIR (P =.90) or decreased OS (P =.11). Among patients with tumors 2 to 3 cm in size, the presence of VPI was associated with increased CIR (P=.015) and decreased OS (P<.001), even after adjusting for histologic subtype. When stage I lung ADCs ≤3 cm were regrouped as either new stage IA (≤2 cm with or without VPI, 2-3 cm without VPI) or new stage IB (2-3 cm with VPI), there was a statistically significant difference in 5-year CIR and OS between new stage IA and new stage IB tumors (CIR, 18% vs 40% [P=.004]; OS, 76% vs 51% [P<.001]). Conclusions: VPI stratifies prognosis in patients with lung ADC 2 to 3 cm but not in those with tumors < 2 cm. Our proposed regrouping of a new stage IB better stratifies patients with poor prognosis, similar to published outcomes in patients with stage II disease, who may benefit from adjuvant chemotherapy. © 2013 American College of Chest Physicians.
Journal Title:	Chest
Volume:	144
Issue:	5
ISSN:	0012-3692
Publisher:	American College of Chest Physicians
Date Published:	2013-11-01
Start Page:	1622
End Page:	1631
Language:	English
DOI:	10.1378/chest.13-0394
PROVIDER:	scopus
PMCID:	PMC3817930
PUBMED:	23807749
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84887432219&partnerID=40&md5=75e35c0e6c85ac0ffa32b9d65db638ce
Notes:	--- - "Export Date: 2 December 2013" - "CODEN: CHETB" - "Source: Scopus"

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