Lung Cancer: Lung Cancer: Diagnosis and Prognosis |

Visceral Pleural Invasion Decreased Overall Survival in Resected Non-small cell Lung Cancer Patients With Tumor Size Ranged 3 to 5 cm Rather Than 3 cm or Less FREE TO VIEW

Ping Zhou; Yuting Jing; Weimin Li
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Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A270. doi:10.1016/j.chest.2016.02.282
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SESSION TITLE: Lung Cancer: Diagnosis and Prognosis

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM

PURPOSE: The purpose of this retrospective study was to evaluate the impact of visceral pleural invasion (VPI) and tumer size ranged 3 to 7cm on overall survival (OS) in surgically resected early stage non-small cell lung cancer (NSCLC) patients with pathologic N0M0.

METHODS: We retrospectively reviewed the clinicopathological characteristics and outcomes of 207 patients with tumor size lesser than 7cm, with surgically resected pathologic stage pN0M0 NSCLC between January 2008 and December 2013 at the West China hospital, Sichuan University. We used the Kaplan-Meier method to assess the association of VPI and tumor size with overall survival (OS). Cox proportional hazards regression model was used for multivariate analyses.

RESULTS: 101 patients (48.8%) had presence VPI, and 106 patients (52.2%) without. Median follow-up was 40.5 months. The 5-year overall survival rate was 80.0% and 63.6% for those with tumor size smaller than 3cm and tumor size ranged 3-5cm, respectively. Kaplan-Meier survival analysis stratified by tumor size showed worse overall survival in patients with VPI (P=0001). And survival rates decreased when the size of the tumor increased (p=0.001). There was a significant effect for the VPI and tumor size (rang 3 to 5cm) interactions for OS (p=0.006), the effects of VPI for other tumor size groups were not significant. Overall survival between tumor size ranged 3-5cm with VPI and tumor size ranged 5-7cm without VPI was not significant (p=0.192). In multivariate analysis, VPI, larger tumor size, older age were significantly associated with decreased OS.

CONCLUSIONS: Our results suggest that the presence of VPI did not influence the overall survival in operated non-small lung cancer patients with tumor size lesser than 3cm, however, VPI decreased overall survival in patients with tumor size ranged 3-5cm. In our study, we suggested that tumors lesser than 3cm with VPI should be treated as T1a not T2, and that tumor size ranged 3 to 5cm could be upstaged to the next T stage in the further TNM staging system. Further larger scale studies with more patients, longer-time follow-up and the depth of VPI should be re-evaluated.

CLINICAL IMPLICATIONS: It thus remains controversial whether the presence of VPI affects overall survival and influenced the upstage according to the tumor size in patients with resected NSCLC. Our study suggested that tumors lesser than 3cm with VPI should be treated as T1a not T2, and that tumor size ranged 3 to 5cm could be upstaged to the next T stage in the further TNM staging system

DISCLOSURE: The following authors have nothing to disclose: Ping Zhou, Yuting Jing, Weimin Li

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