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Original Research: Lung Cancer |

Visceral Pleural Invasion Does Not Affect Recurrence or Overall Survival Among Patients With Lung Adenocarcinoma ≤ 2 cmVisceral Pleural Invasion in Lung Adenocarcinoma: A Proposal to Reclassify T1 Lung Adenocarcinoma

Jun-ichi Nitadori, MD, PhD; Christos Colovos, MD, PhD; Kyuichi Kadota, MD, PhD; Camelia S. Sima, MD; Inderpal S. Sarkaria, MD; Nabil P. Rizk, MD; Valerie W. Rusch, MD, FCCP; William D. Travis, MD, FCCP; Prasad S. Adusumilli, MD, FCCP
Author and Funding Information

From the Division of Thoracic Surgery (Drs Nitadori, Colovos, Kadota, Sarkaria, Rizk, Rusch, and Adusumilli), Department of Epidemiology and Biostatistics (Dr Sima), Department of Pathology (Dr Travis), and Center for Cell Engineering (Dr Adusumilli), Memorial Sloan-Kettering Cancer Center, New York, NY.

Correspondence to: Prasad S. Adusumilli, MD, FCCP, Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; e-mail: adusumip@mskcc.org


Funding/Support: This work was supported by the International Association for the Study of Lung Cancer (Young Investigator Award); American Association for Thoracic Surgery (Third Edward D. Churchill Research Scholarship); National Lung Cancer Partnership/LUNGevity Foundation (research grant); American Association for Cancer Research lung cancer translational research award; New York State Empire Clinical Research Investigator Program; William H. and Alice Goodwin and the Commonwealth Foundation for Cancer Research and the Experimental Therapeutics Center; National Cancer Institute [Grants 1R21CA164568-01A1, 1R21CA164585-01A1, U54CA137788, and U54CA132378]; and the US Department of Defense [Grants PR101053 and LC110202].

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


Chest. 2013;144(5):1622-1631. doi:10.1378/chest.13-0394
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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.

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