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

Hung, Jan Jong; Jeng, Wen Juei; Hsu, Wen Hu; Chou, Teh Ying; Lin, Sheng-Fuu; Wu, Yu Chung

doi:10.1378/chest.11-2552

Cited by 37 publications

(35 citation statements)

References 28 publications

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“…24 2000–2009TurkeyNAI-IVNA96343742.5%H&E and elastic stainingAC and SCCLobectomy/bilobectomy pneumonectomy lobectomy + chest wall resection and pneumonectomy + chest wall resectionNo7Chang Y. L. 11 1990–2008Taiwan64I-IIINANA151170—H&E and elastic stainingAC, SCC and ASCLobectomyYes7Hung J. J. 12 1990–2006Taiwan67I-II4.5NA30055—H&E and elastic stainingAC, SCC, LCCs and othersPneumonectomy bilobectomy, lobectomy and sublobar resectionNo7Kudo Y. 14 2000–2007Japan66I-III4.66921326221.9%H&E and elastic stainingAC, SCC, LCC and othersPneumonectomy bilobectomy and lobectomyYes7Hung J. J.…”

Section: Resultsmentioning

confidence: 99%

“…Only three studies contributed data to the analyses of recurrence-free survival 12, 19, 31 . Two studies compared recurrence-free survival between PL1 and PL0 patients 19, 31 , two studies compared PL2 with PL0 patients 19, 31 and two studies compared PL2 with PL1 patients 12, 19 .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies compared recurrence-free survival between PL1 and PL0 patients 19, 31 , two studies compared PL2 with PL0 patients 19, 31 and two studies compared PL2 with PL1 patients 12, 19 . Significant heterogeneity was found between studies in PL2 versus PL0 comparison group (I 2 = 90%, p = 0.002), while significant heterogeneity was not found in PL1 versus PL0 and PL2 versus PL1 comparison groups.…”

Section: Resultsmentioning

confidence: 99%

“…Likewise, Hung J. J. et al . reported patients with PL2 had significantly worse overall survival and lower probability of freedom from recurrence than those with PL1 after resection of node-negative NSCLC 12 . And some other studies also reached positive results 13–15 .…”

Section: Introductionmentioning

confidence: 90%

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Extent of Visceral Pleural Invasion Affects Prognosis of Resected Non-small Cell Lung Cancer: A meta-analysis

Wang

Zhou

2017

Sci Rep

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Visceral pleural invasion (VPI) has been known to be an adverse prognostic factor in non-small cell lung cancer (NSCLC). However, the prognostic significance of extent of VPI (PL0, PL1 and PL2) remains controversial. We conduct a meta-analysis to summarize available evidence on this topic. PubMed, EMBASE, OVID and The Cochrane Library were searched for published studies from inception to May 9, 2016. A total of 16 studies were included in meta-analysis. Our results showed that patients with PL1 or PL2 had poorer overall survival compared with PL0 (HR = Lung cancer is the leading cause of cancer death worldwide. Visceral pleural invasion (VPI), since 1970s, has been adopted as a T descriptor in the TNM classification and known to be an adverse prognostic factor in non-small cell lung cancer (NSCLC) [1][2][3] . The 7th edition TNM staging system of lung cancer recommended the classification of pleural invasion as PL0 if the tumor does not invade past the elastic layer, as PL1 if it invades past the elastic layer, PL2 if it invades to the pleural surface and PL3 if it invades to the parietal pleura 4 . PL1 and PL2 were defined as VPI and PL0 was defined as without VPI.1However, the International Association for the Study of Lung Cancer (IASLC) team didn't analysis and validate the prognosis of PL status in the 7th TMN classification of lung cancer because of insufficient data to be submitted 3 . Most studies investigated the prognostic value of VPI without distinguishing the extent of VPI (PL1 and PL2) [5][6][7][8][9][10] . It is still unclear whether PL1 and PL2 are equivalent and whether they should be combined to define VPI, or how tumors with PL1 and PL2 should be classified. Recently, Chan YL and associates reported resected NSCLC patients with PL2 had significant worse survival than those with PL1 and suggested PL2 to be a potential indication for adjuvant chemotherapy 11 . Likewise, Hung J. J. et al. reported patients with PL2 had significantly worse overall survival and lower probability of freedom from recurrence than those with PL1 after resection of node-negative NSCLC 12 . And some other studies also reached positive results [13][14][15] . Contrary to the studies mentioned above, there were some other studies that didn't find the survival difference between PL1 and PL2 patients [16][17][18][19][20][21][22][23][24] . Thus, the evidence on this topic remains controversial. Our previously study has demonstrated that VPI is a consistent adverse prognostic factor in stage I NSCLC patients 25 . In this study, we focused on the prognostic significance of PL0, PL1 and PL2 and aimed to answer the question whether PL2 has worse prognosis than PL1 in resected NSCLC patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

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Extent of Visceral Pleural Invasion Affects Prognosis of Resected Non-small Cell Lung Cancer: A meta-analysis

Wang

Zhou

2017

Sci Rep

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“…In patients with tumors ≤3 cm, when analyzed according to pl0, pl1, and pl2, the percentages of pN0 patients were 89.1%, 76.9%, and 74.1%, respectively (pl0 vs. pl1, p = 0.002; pl0 vs. pl2, p = 0.02; pl1 vs. pl2, p = 0.83) (data not shown). Pl2 was previously reported to be a more significant prognostic factor for worse OS than pl1 in node-negative NSCLC with VPI [26,27]. In tumors ≤3 cm without lymph node metastasis in the current study, the 5-year OS rates of pl0, pl1, and pl2 patients were 86.6%, 81.6%, and 63.4%, respectively (pl0 vs. pl1, p = 0.80; pl0 vs. pl2, p = 0.008; pl1 vs. pl2, p = 0.14) (data not shown).…”

Section: Discussionmentioning

confidence: 97%

Impact of visceral pleural invasion on the survival of patients with non-small cell lung cancer

et al. 2012

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Impact of visceral pleural invasion on the association of extent of lymphadenectomy and survival in stage I non‐small cell lung cancer

Zhao

Qiu

et al. 2019

Cancer Medicine

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Visceral pleural invasion (VPI) has been identified as an adverse prognostic factor for non‐small cell lung cancer (NSCLC). Accurate nodal staging for NSCLC correlates with improved survival, but it is unclear whether tumors with VPI require a more extensive lymph nodes (LNs) dissection to optimize survival. We aimed to evaluate the impact of VPI status on the optimal extent of LNs dissection in stage I NSCLC, using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 9297 surgically treated T1‐2aN0M0 NSCLC patients with at least one examined LNs. Propensity score matching was conducted to balance the baseline clinicopathologic characteristics between the VPI group and non‐VPI group. Log‐rank tests along with Cox proportional hazards regression methods were performed to evaluate the impact of extent of LNs dissection on survival. VPI was correlated with a significant worse survival, but there was no significant difference in survival rate between PL1 and PL2. Patients who underwent sublobectomy had slightly decreased survival than those who underwent lobectomy. Pathologic LNs examination was significantly correlated with survival. Examination of 7‐8 LNs and 14‐16 LNs conferred the lowest hazard ratio for T1‐sized/non‐VPI tumors (stage IA) and T1‐sized/VPI tumors (stage IB), respectively. The optimal extent of LNs dissection varied by VPI status, with T1‐sized/VPI tumors (stage IB) requiring a more extensive LNs dissection than T1‐sized/non‐VPI tumors (stage IA). These results might provide guidelines for surgical procedure in early stage NSCLC.

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

Cited by 37 publications

References 28 publications

Extent of Visceral Pleural Invasion Affects Prognosis of Resected Non-small Cell Lung Cancer: A meta-analysis

Extent of Visceral Pleural Invasion Affects Prognosis of Resected Non-small Cell Lung Cancer: A meta-analysis

Impact of visceral pleural invasion on the survival of patients with non-small cell lung cancer

Impact of visceral pleural invasion on the association of extent of lymphadenectomy and survival in stage I non‐small cell lung cancer

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