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Prognostic significance of visceral pleural invasion in the forthcoming (seventh) edition of TNM classification for lung cancer

 Hyo Sup Shim  ;  In Kyu Park  ;  Chang Young Lee  ;  Kyung Young Chung 
 LUNG CANCER, Vol.65(2) : 161-165, 2009 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/classification* ; Carcinoma, Non-Small-Cell Lung/mortality ; Carcinoma, Non-Small-Cell Lung/pathology* ; Female ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms/classification* ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology* ; Male ; Middle Aged ; Neoplasm Invasiveness/pathology ; Neoplasm Staging/classification* ; Pleura/pathology ; Prognosis
Non-small-cell lung carcinoma ; Visceral pleural invasion ; Tumor size ; Cancer staging ; TNM classification ; Prognosis
BACKGROUND: The next revision to the TNM classification for lung cancer (the seventh edition) is scheduled to be released in 2009. However, the definition of visceral pleural invasion (VPI), which is a non-size-based T2 descriptor, still lacks in detail, and its validation is not included. METHODS: We analyzed 1046 cases of non-small cell lung cancer (NSCLC) with T1, T2, or T3 diseases from 1990 to 2005, and subclassified into p0-p3 according to the degrees of pleural invasion. Survival analyses were performed using Kaplan-Meier method. Then, all patients were subdivided into nine groups according to tumor size and pleural invasion, and we compared survival differences, primarily focusing on T2a and T2b diseases according to the seventh edition. RESULTS: There was no survival difference between patients with p1 and p2, thus we regarded p1 or p2 as VPI. There was survival difference between two groups, which are expected to be classified as T2b. The behavior of tumors larger than 5cm but 7cm or less with VPI was similar to T3 tumors. CONCLUSIONS: VPI is a poor prognostic factor of NSCLC, and the penetration through the elastic layer of the visceral pleura regardless of its exposure on the pleural surface (pl and p2) should be defined as VPI. This study also indicates that VPI influences T stage dependent on tumor size, and it can be suggested that tumors of larger than 5cm but 7cm or less with VPI should be upgraded to T3 stage.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Park, In Kyu(박인규)
Shim, Hyo Sup(심효섭) ORCID logo https://orcid.org/0000-0002-5718-3624
Lee, Chang Young(이창영)
Chung, Kyung Young(정경영)
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