Novel biologic factors correlated to visceral pleural invasion in early-stage non-small cell lung cancer less than 3 cm

Deng, Han‐Yu; Li, Gang; Luo, Jun; Alai, Gu-Ha; Zhuo, Ze-Guo; Lin, Yi‐Dan

doi:10.21037/jtd.2018.03.185

Cited by 16 publications

(16 citation statements)

References 22 publications

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“…Pleural involvement was linked to regional tumor proliferation, recurrence, and subsequent treatment failure (16,22,23). Deng et al (24) found that patients with VPI were more likely to have poorly differentiated tumors, tumor plugs, and LN metastasis. Some retrospective studies showed that the survival rate of ≤3 cm TS tumors with VPI was lower than that with no VPI, which supported the 8th TNM staging system (10,(25)(26)(27)(28).…”

Section: Pl2mentioning

confidence: 99%

Rethinking the Selection of Pathological T-Classification for Non-Small-Cell Lung Cancer in Varying Degrees of Visceral Pleural Invasion: A SEER-Based Study

Fang

Cheng

et al. 2022

Front. Surg.

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BackgroundThe T classification of non-small-cell lung cancer (NSCLC) was upgraded from T1 to T2 when accompanied by visceral pleural invasion (VPI). However, the association between VPI and prognostic outcomes was obscure in NSCLC patients with â‰¤3 cm tumor size (TS), which leaded the controversy of selection of T classification. The goal was to evaluate the effect of VPI on the prognosis of NSCLC with â‰¤ 3cm TS and present a modified T classification.MethodsA total of 14,934 NSCLC patients without distant metastasis were recruited through a retrospective study in the SEER database. The effect of VPI on lung cancer specific survival (LCSS) was evaluated using survival curve and COX regression analysis in NSCLC patients with ≤3 cm TS.ResultsAlthough there was no difference of the LCSS of PL0 and PL1 patients with ≤2 cm TS in patients without lymph node (LN) metastasis, the LCSS was lower in PL2 patients than those in PL0 (T1a: p < 0.001; T1b: p = 0.001). Moreover, the LCSS was decreased in PL1 and PL2 patients with 2–3 cm TS compared with PL0 (T1c: PL1, p < 0.001; PL2, p = 0.009) of patients without LN metastasis. No difference of LCSS was observed in patients with LN metastasis between PL0 with PL1 and PL2.ConclusionIn NSCLC patients without LN metastasis and TS ≤ 2 cm, tumor with PL1 should remain defined as T1, tumor with PL2 should be defined as T2. However, 2–3 cm TS patients with PL1 or PL2 should both defined as T2. Meanwhile, ≤3 cm TS patients with LN metastasis can be regarded as T1, whether NSCLC patients accompanied with PL1 or PL2.

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Section: Pl2mentioning

confidence: 99%

Rethinking the Selection of Pathological T-Classification for Non-Small-Cell Lung Cancer in Varying Degrees of Visceral Pleural Invasion: A SEER-Based Study

Fang

Cheng

et al. 2022

Front. Surg.

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“…Previous studies have shown that patients with visceral pleural invasion (VPI) yield significantly worse survival rates than patients without, therefore according to 8th edition of the TNM classification for NSCLC its presence increases the T descriptor from T1 to T2 and upstages a tumour from stage IA to stage IB, even if smaller than 3 cm in size (41). Also in early stage lung cancer, the prognostic relevance of this feature has been demonstrated (42,43) although not predictable by radiographic study and usually reported in low rate of patients (44).…”

Section: Pleural Invasionmentioning

confidence: 99%

Early stage lung cancer: pathologist’s perspective

Boggio¹,

Gobbo²,

Croci³

et al. 2020

J Thorac Dis

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Presurgical diagnosisAlbeit considered less relevant in comparison to stage IV cancer, obtaining a cytological presurgical diagnosis of early lesion is strongly recommended whenever feasible (1).The most common procedure used in clinical practice are represented by bronchoscopy, endobronchial ultrasound and CT-guided biopsy.Those techniques demonstrated, in the recent years, satisfying rate of diagnostic adequacy and to provide enough material also for molecular testing (2-4).When dealing with small (<1 or 1.5 cm) lesions several authors advise that performing CT-guided fine-needle aspiration can produce high diagnostic reliability rates (5-8).Considered the increasing incidence of lung cancer diagnosed at early stage, the pathologist should be aware of the essential information's he is asked to provide for the correct management of the patient.Prior to the 2000s, lung cancer was classified into the following two major groups: small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC) (encompassing squamous cell carcinoma, adenocarcinoma (ADC), large cell lung carcinoma and sarcomatoid carcinoma).Nowadays the new WHO classification of lung tumors (9)no longer supports this strategy, stressing the use of the specific terminology of ADC and squamous cell carcinoma (SCC) (versus SCLC) as much as possible.The use the nomenclature "non-small cell lung carcinoma not otherwise specified" (NSCLC-NOS) should be saved for selected cases when a more precise diagnosis is not achievable considering both cytomorphology and immunohistochemistry. MorphologyMorphological clues of glandular differentiation in ADC are expressed cytologically in different features: papillae with central fibrovascular cores, pseudopapillae, group of cells organized in flat sheets or three-dimensional structures, clusters with acinar structures with picket fence or honeycomb-like arrangement (10-13).Cytologically cytoplasms in ADC usually are basophilic with homogeneous, granular or foamy appearance. Frequently cytoplasmic vacuoles can also be spotted.Nuclei are usually eccentrically located with delicately granular, hyperchromatic or uniform chromatin arrangement. Macronucleoli represent a common finding.On the other hand, squamous differentiation must be suspected with evidence of keratinization, pearls and intercellular bridges.Cells usually show opaque or dense cytoplasm, less translucent compared to other NSCLC hystotypes. Cellular contours generally have rounded, ovoid or streched shape and nuclei are usually central, hyperchromatic, with rectangular outlines and squared-off edges.Not infrequently chromatin is pyknotic meanwhile nucleoli are usually non-evident (10-13).Unfortunately, morphology alone is frequently not a straightforward tool for a specific cytological differentiation, in this contest immunohistochemistry play the major role in distinguishing ADC versus SCC. ImmunohistochemistryLimited immunohistochemical panel are strongly suggested in order to spare as much material as possible for

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“…During the past several decades literature has widely demonstrated that patients with VPI have worse outcomes and poorer survival, with higher frequency of pleural effusion, lymph node metastasis and postoperative recurrence (5,6). There is still controversy in the global management of these patients, from the preoperative staging to the optimal surgical procedure and the postoperative follow-up or the need of adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Non-small-cell lung cancer involving the pleura: a narrative review on the diagnostic and therapeutic pathway

Gonfiotti¹,

Gatteschi²,

Salvicchi³

et al. 2021

Curr Chall Thorac Surg

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Visceral pleural invasion (VPI) is considered a challenging topic in the management of patients with non-small-cell lung cancer (NSCLC) since it has been incorporated into the last edition of tumor, node, metastasis (TNM) staging as a size independent T2 factor. VPI presents adverse outcomes and poorer prognosis, with higher rate of mediastinal lymph node metastases and malignant pleural effusion. In literature few studies investigated it, therefore there is still debate on the global management of these patients, from the preoperative staging to the optimal surgical procedure and the postoperative follow-up or the need of adjuvant chemotherapy. Our work is a narrative review taking into consideration the most recent and relevant articles concerning VPI and NSCLC. We have summarized the most appropriate diagnostic pathway, surgical approach and post-operative management in order to give these patients the best therapeutic option. The preoperatively prediction of pleural invasion is still too weak to ensure a preoperative upstaging. On the other hand, lobectomy with adequate lymph node dissection seems to be the most appropriate therapeutic option in these patients. Furthermore, there is no evidence of the usefulness of adjuvant chemotherapy and the lack of clinical trials leads clinicians to evaluate case-by-case the global management of these patients.

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Novel biologic factors correlated to visceral pleural invasion in early-stage non-small cell lung cancer less than 3 cm

Abstract: Besides shorter distance to visceral pleura and pleural indentation, elderly, adenocarcinoma, and poor tumor differentiation were novel biologic factors correlated to VPI in early-stage NSCLC, which may explain why VPI was an unfavorable prognostic factor for early-stage NSCLC.

Cited by 16 publications

References 22 publications

Rethinking the Selection of Pathological T-Classification for Non-Small-Cell Lung Cancer in Varying Degrees of Visceral Pleural Invasion: A SEER-Based Study

Rethinking the Selection of Pathological T-Classification for Non-Small-Cell Lung Cancer in Varying Degrees of Visceral Pleural Invasion: A SEER-Based Study

Early stage lung cancer: pathologist’s perspective

Non-small-cell lung cancer involving the pleura: a narrative review on the diagnostic and therapeutic pathway

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