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Original Research: Lung Cancer |

Prognostic Significance of Visceral Pleural Involvement in Early-Stage Lung CancerPrognostic Impact of Visceral Pleural Involvement

Sameer Lakha, BA; Jorge E. Gomez, MD; Raja M. Flores, MD, FCCP; Juan P. Wisnivesky, MD, DrPH
Author and Funding Information

From the Division of General Internal Medicine (Mr Lakha and Dr Wisnivesky), Tisch Cancer Institute (Dr Gomez), Department of Thoracic Surgery (Dr Flores), and Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Wisnivesky), Icahn School of Medicine at Mount Sinai, New York, NY.

CORRESPONDENCE TO: Sameer Lakha, BA, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, Box 1087, New York, NY 10029; e-mail: slakha@post.harvard.edu


Part of this article was presented in abstract form at the American Thoracic Society International Conference, May 19, 2014, San Diego, CA.

FUNDING/SUPPORT: The authors report to CHEST that no funding or other support was received for this study.

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


Chest. 2014;146(6):1619-1626. doi:10.1378/chest.14-0204
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BACKGROUND:  Visceral pleural invasion (VPI) may impact non-small cell lung cancer (NSCLC) survival. However, previous studies are mixed as to whether VPI is an independent prognostic factor in early-stage cancers and whether its effect is size dependent. In the current American Joint Committee on Cancer (AJCC) staging system, VPI leads to upstaging of cancers < 3 cm but not of those 3 to 7 cm in size.

METHODS:  Using the Surveillance, Epidemiology, and End Results (SEER) registry, we identified 16,315 patients with stage I-II NSCLC treated with lobectomy. We used the Kaplan-Meier method and Cox regression to assess the association of VPI with lung cancer-specific (primary outcome) and overall survival. Based on these results, we created a revised VPI staging classification.

RESULTS:  Overall, 3,389 patients (21%) had VPI. Kaplan-Meier analysis stratified by tumor size showed worse cancer-specific survival in patients with VPI (P < .0001). VPI was independently associated with decreased lung cancer-specific survival (hazard ratio, 1.38; 95% CI, 1.29-1.47) after controlling for tumor size and other confounders; this effect was not size dependent. In our revised classification, tumors < 7 cm with VPI were upstaged to the next T category.

CONCLUSIONS:  VPI is a prevalent finding associated with worse prognosis in early-stage lung cancer, even among patients with tumors > 3 cm, a factor not captured in the current staging system. Patients with VPI may be considered candidates for more aggressive treatment.

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