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Original Research |

Prognostic Significance of the Extent of Visceral Pleural Invasion in Completely Resected Node-Negative Non-small Cell Lung CancerPrognostic Value of Visceral Pleural Invasion

Jung-Jyh Hung, MD, PhD; Wen-Juei Jeng, MD; Wen-Hu Hsu, MD; Teh-Ying Chou, MD, PhD; Shiou-Fu Lin, MD; Yu-Chung Wu, MD; International Association for the Study of Lung Cancer International Staging Committee
Author and Funding Information

From the Division of Thoracic Surgery (Drs Hung, Hsu, and Wu), Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University; Department of Internal Medicine (Dr Jeng), Chang Gung Memorial Hospital, Chang Gung University; Institute of Clinical Medicine (Dr Chou), National Yang-Ming University; and Department of Pathology and Laboratory Medicine (Drs Chou and Lin), Taipei Veterans General Hospital, Taipei, Taiwan.Drs Hung and Wu contributed equally to this article.

Correspondence to: Jung-Jyh Hung, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Rd, Taipei 112, Taiwan; e-mail: bradley.hung@gmail.com

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Funding/Support: This work was supported in part by National Science Council [NSC-100-2314-B-075-001] (Dr Hung) and NSC-100-2314-B-075-004-MY2 (Dr Wu)], Center of Excellence for Cancer Research at Taipei Veterans General Hospital [DOH100-TD-C-111-007] (Dr Wu), Yen Tjing Ling Medical Foundation [CI-100-15] (Dr Hung) and Taipei Veterans General Hospital [V101B-038] (Dr Hung).


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This work was supported in part by National Science Council [NSC-100-2314-B-075-001] (Dr Hung) and NSC-100-2314-B-075-004-MY2 (Dr Wu)], Center of Excellence for Cancer Research at Taipei Veterans General Hospital [DOH100-TD-C-111-007] (Dr Wu), Yen Tjing Ling Medical Foundation [CI-100-15] (Dr Hung) and Taipei Veterans General Hospital [V101B-038] (Dr Hung).


Chest. 2012;142(1):141-150. doi:10.1378/chest.11-2552
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Objective:  Visceral pleural invasion (VPI) has been defined as invasion of the tumor beyond the elastic layer (PL1), including invasion to the visceral pleural surface (PL2). The aim of this study was to evaluate the prognostic factors and patterns of recurrence in resected node-negative non-small cell lung cancer (NSCLC) with VPI.

Methods:  We retrospectively reviewed the clinicopathologic characteristics of 355 patients with resected node-negative NSCLC with VPI at Taipei Veterans General Hospital between 1990 and 2006. The prognostic value and patterns of recurrence were analyzed and compared between PL1 and PL2 groups.

Results:  The median follow-up time was 54.2 months. The 5-year overall survival rate and probability of freedom from recurrence were 61.9% and 66.2%, respectively. The extent of VPI was PL1 in 300 patients (84.5%) and PL2 in 55 (15.5%). During follow-up, 107 patients (30.1%) developed recurrence. The patterns of recurrence included local recurrence only in 20 patients (18.7%), distant metastasis only in 59 (55.1%), and both local recurrence and distant metastasis in 28 (26.2%). Thirteen of the 107 patients (12.1%) with recurrence developed malignant pleural effusion. The percentage of malignant pleural effusion in the PL2 group was significantly higher than that in the PL1 group (P = .006). Patients with PL2 had significantly worse overall survival (P = .046) and lower probability of freedom from recurrence (P = .028) in multivariate analysis.

Conclusions:  PL2 was a significant prognostic factor for recurrence and worse overall survival in node-negative NSCLC with VPI. This information is important for further design of clinical trials for aggressive adjuvant therapy.

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