The Effect of Visceral Pleura Invasion in the Resected Stage IB Non-Small Cell Lung Cancer Patients.

Abstract

Purpose: The purpose of this study was to clarify the prognostic significance of visceral pleura invasion in T2N0M0 non-small cell lung cancer (NSCLC). Materials and Methods: Between Jan. 1990 and Dec. 2001, 213 consecutive patients with T2N0M0 NSCLC underwent complete surgical resection. The patients were divided into two groups according to the existence of visceral pleural invasion. P1 and P2 defined by Hammar's definition were included in visceral pleural invasion group. The follow-up was carried out completely without missing case. The median follow-up period was 34.4 months, ranging from 0.13 to 156.2 months. Results: Patient ages ranged from 10 to 79 years (mean: 60.1 years, median : 62 years). Visceral invasion was identified in 55 patients (25.8%). The operation included lobectomy in 110, pneumonectomy in 67, bi-lobectomy in 36 patients. Histology was squamous cell carcinoma in 110, adenocarcinoma in 72, large cell carcinoma in 13, others in 18. There were 5 hospital mortality (2.3%) and 71 late mortality (33.3%). 27 (50.94%) and 44 (28.4%) of late mortality were in visceral pleural invasion group (Group I) and visceral pleural non-invasion group (Group II) respectively (p=0.002). Overall 5-year survival rate was 44.8% in Group I and 63.5% in group II (p=0.0017). There were 55 (25.8%) postoperative recurrences, 24(43.6%) in group I, 21 (13.3%) in group II (p<0.0001). There were 60 recurrence sites, 58 (96.7%) of them were distant metastases, 2 (3.3%) were local recurrences. Conclusion: Visceral pleural invasion is a significant prognostic factor in stage IB NSCLC in survival time and recurrence. The postoperative adjuvant systemic therapy can be thought in stage IB NSCLC with visceral pleural invasion.