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J Thorac Cardiovasc Surg 2005;130:160-165
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer

^a Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
^b Division of Thoracic and Visceral Organ Surgery, Gunma University Faculty of Medicine, Gunma, Japan
^c Pathology Division, National Cancer Center Research Institute East, Chiba, Japan

Received for publication September 21, 2004; revisions received October 31, 2004; accepted for publication November 9, 2004.

^_* Address for reprints: Kimihiro Shimizu, MD, Division of Thoracic and Visceral Organ Surgery, Gunma University Faculty of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma, 371-8511, Japan (Email: kmshimiz{at}showa.gunma-u.ac.jp).

OBJECTIVE: Although visceral pleural invasion by non-small cell lung cancer is considered a poor-prognostic factor, further information is lacking, especially in relation to other clinicopathologic prognostic factors. We assessed the relationship between visceral pleural invasion and other clinicopathologic characteristics and evaluated its significance as a prognostic factor.

METHODS: We reviewed 1074 patients with surgically resected T1/2 non-small cell lung cancer for their clinicopathologic characteristics and prognoses. The patients were divided into 2 groups according to visceral pleural invasion status (visceral pleural invasion group and non-visceral pleural invasion group). Both groups were compared with regard to age, sex, histology, tumor size, tumor differentiation, lymph node involvement, lymphatic invasion, vascular invasion, scar grade, nuclear atypia, mitotic index, serum carcinoembryonic antigen level, and survival. Univariate and multivariate analyses were conducted.

RESULTS: Visceral pleural invasion was identified in 288 (26.8%) of the resected specimens. Survival was 76.0% at 5 years and 53.2% at 10 years in the non-visceral pleural invasion group and was 49.8% at 5 years and 37.0% at 10 years in the visceral pleural invasion group. The difference between groups was highly significant (P < .0001). Visceral pleural invasion was also significantly associated with a higher frequency of lymph node involvement. However, regardless of N status (N0 or N1/2), there was a significant difference in survival when the visceral pleura was invaded. Visceral pleural invasion was observed significantly more frequently in tumors with factors indicative of tumor aggressiveness/invasiveness: moderate/poor differentiation, lymphatic invasion, vascular invasion, high scar grade, high nuclear atypia grade, high mitotic index, and high serum carcinoembryonic antigen level. By multivariate analysis, visceral pleural invasion proved to be a significant independent predictor of poor prognosis in non-small-cell lung cancer patients with or without lymph node involvement.

CONCLUSIONS: Visceral pleural invasion is a significant poor-prognostic factor, regardless of N status. Our analyses indicated that visceral pleural invasion is an independent indicator of non-small cell lung cancer invasiveness and aggressiveness.

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