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Modification of Pathologic T Classification for Non-small Cell Lung Cancer With Visceral Pleural Invasion

医学 内科学 分布式文件系统 肺癌 污渍 H&E染色 辅助治疗 胃肠病学 总体生存率 癌症 病理 免疫组织化学 染色 计算机安全 计算机科学
作者
Run-Bin Liang,Peng Li,Bob T. Li,Jie-Tian Jin,Valerie W. Rusch,David R. Jones,Yi‐Long Wu,Qing Liu,Jie Yang,Mu‐Zi Yang,Shuo Li,Hao Long,Jianhua Fu,Lanjun Zhang,Peng Lin,Tiehua Rong,Xue Hou,Suxia Lin,Hao‐Xian Yang
出处
期刊:Chest [Elsevier BV]
卷期号:160 (2): 754-764 被引量:15
标识
DOI:10.1016/j.chest.2021.03.022
摘要

Visceral pleural invasion (VPI) with PL1 or PL2 increases the T classification from T1 to T2 in non-small cell lung cancers (NSCLCs) ≤ 3 cm. We proposed a modified T classification based on VPI to guide adjuvant therapy.Is it reasonable to upstage PL1-positive cases from T1 to T2 for NSCLCs ≤ 3 cm?In total, 1,055 patients with resected NSCLC were retrospectively included. Tumor sections were restained with hematoxylin and eosin stain and Victoria blue elastic stain for the elastic layer. Disease-free survival (DFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Subgroup analysis and a Cox proportional hazards model were used to further determine the impact of VPI on survival.The extent of VPI was diagnosed as PL0 in 824 patients, PL1 in 133 patients, and PL2 in 98 patients. The 5-year DFS rates of patients with PL0, PL1, and PL2 were 62.6%, 60.2%, and 28.8% (P < .01), whereas the corresponding 5-year OS rates were 78.6%, 74.4%, and 50.0% (P < .01), respectively. As predicted, the DFS and OS of patients with PL2 were much worse than those of patients with PL0 (P < .01) and PL1 (P < .01). However, both the DFS and OS of patients with PL0 and PL1 were comparable (DFS: P = .198; OS: P = .150). For node-negative cases, the DFS and OS of patients with PL0 and PL1 were also comparable (DFS: P = .468; OS: P = .388), but patients with PL2 had much worse DFS and OS than patients with PL0 (P < .01) and PL1 (P < .01). Multivariable analyses suggested that PL2, together with node positivity and poor cell differentiation, was an independent adverse prognostic factor.In NSCLCs ≤ 3 cm, tumors with PL1 should remain defined as T1, not T2. Overtreatment by adjuvant chemotherapy in node-negative NSCLCs ≤ 3 cm might be avoided in PL1 cases.
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