Abstract
Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 890-902 |
| Number of pages | 13 |
| Journal | Journal of Thoracic Oncology |
| Volume | 14 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2019 |
Keywords
- Lung cancer survival
- Lymphatic
- Pleural
- Small lung cancers
- Vascular invasion
ASJC Scopus subject areas
- Oncology
- Pulmonary and Respiratory Medicine
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Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm. / Yip, Rowena; Ma, Teng; Flores, Raja M.; Yankelevitz, David; Henschke, Claudia I.; Yankelevitz, David F.; Salvatore, Mary; Flores, Raja; Wolf, Andrea; Chen, Mildred; Libby, Daniel M.; Smith, James P.; Pasmantier, Mark; Reeves, A. P.; Markowitz, Steven; Miller, Albert; Deval, Jose Cervera; Roberts, Heidi; Patsios, Demetris; Sone, Shusuke; Hanaoka, Takaomi; Zulueta, Javier; de-Torres, Juan P.; Lozano, Maria D.; Aye, Ralph; Manning, Kristin; Bauer, Thomas; Canitano, Stefano; Giunta, Salvatore; Cole, Enser; Klingler, Karl; Austin, John H.M.; Pearson, Gregory D.N.; Shaham, Dorith; Aylesworth, Cheryl; Meyers, Patrick; Andaz, Shahriyour; Vafai, Davood; Naidich, David; McGuinness, Georgeann; Sheppard, Barry; Rifkin, Matthew; Thorsen, M. Kristin; Hansen, Richard; Kopel, Samuel; Mayfield, William; Luedke, Dan; Klippenstein, Donald; Litwin, Alan; Loud, Peter A.; Kohman, Leslie J.; Scalzetti, Ernest M.; Thurer, Richard; Villamizar, Nestor; Khan, Arfa; Shah, Rakesh; Liu, Xueguo; Herzog, Gary; Yeh, Diana; Wu, Ning; Lowry, Joseph; Frumiento, Carmine; Mendelson, David S.; Smith, Michael V.; Korst, Robert; Taylor, Jana; Ginsberg, Michelle S.; Straznicka, Michaela; Widmann, Mark; Cecchi, Gary; Matalon, Terence A.S.; Scheinberg, Paul; Odzer, Shari Lynn; Olsen, David; Grannis, Fred; Rotter, Arnold; Ray, Daniel; Mullen, David; Wiernik, Peter H.; Cheung, Edson H.; Lim, Melissa; DeCunzo, Louis; Glassberg, Robert; Pass, Harvey; Endress, Carmen; Yoder, Mark; Shah, Palmi; Welch, Laura; Kalafer, Michael; Green, Jeremy; Walsh, James; Bertsch, David; Camacho, Elmer; Chin, Cynthia; O'Brien, James; Willey, James C.
In: Journal of Thoracic Oncology, Vol. 14, No. 5, 05.2019, p. 890-902.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm
AU - Yip, Rowena
AU - Ma, Teng
AU - Flores, Raja M.
AU - Yankelevitz, David
AU - Henschke, Claudia I.
AU - Yankelevitz, David F.
AU - Salvatore, Mary
AU - Flores, Raja
AU - Wolf, Andrea
AU - Chen, Mildred
AU - Libby, Daniel M.
AU - Smith, James P.
AU - Pasmantier, Mark
AU - Reeves, A. P.
AU - Markowitz, Steven
AU - Miller, Albert
AU - Deval, Jose Cervera
AU - Roberts, Heidi
AU - Patsios, Demetris
AU - Sone, Shusuke
AU - Hanaoka, Takaomi
AU - Zulueta, Javier
AU - de-Torres, Juan P.
AU - Lozano, Maria D.
AU - Aye, Ralph
AU - Manning, Kristin
AU - Bauer, Thomas
AU - Canitano, Stefano
AU - Giunta, Salvatore
AU - Cole, Enser
AU - Klingler, Karl
AU - Austin, John H.M.
AU - Pearson, Gregory D.N.
AU - Shaham, Dorith
AU - Aylesworth, Cheryl
AU - Meyers, Patrick
AU - Andaz, Shahriyour
AU - Vafai, Davood
AU - Naidich, David
AU - McGuinness, Georgeann
AU - Sheppard, Barry
AU - Rifkin, Matthew
AU - Thorsen, M. Kristin
AU - Hansen, Richard
AU - Kopel, Samuel
AU - Mayfield, William
AU - Luedke, Dan
AU - Klippenstein, Donald
AU - Litwin, Alan
AU - Loud, Peter A.
AU - Kohman, Leslie J.
AU - Scalzetti, Ernest M.
AU - Thurer, Richard
AU - Villamizar, Nestor
AU - Khan, Arfa
AU - Shah, Rakesh
AU - Liu, Xueguo
AU - Herzog, Gary
AU - Yeh, Diana
AU - Wu, Ning
AU - Lowry, Joseph
AU - Frumiento, Carmine
AU - Mendelson, David S.
AU - Smith, Michael V.
AU - Korst, Robert
AU - Taylor, Jana
AU - Ginsberg, Michelle S.
AU - Straznicka, Michaela
AU - Widmann, Mark
AU - Cecchi, Gary
AU - Matalon, Terence A.S.
AU - Scheinberg, Paul
AU - Odzer, Shari Lynn
AU - Olsen, David
AU - Grannis, Fred
AU - Rotter, Arnold
AU - Ray, Daniel
AU - Mullen, David
AU - Wiernik, Peter H.
AU - Cheung, Edson H.
AU - Lim, Melissa
AU - DeCunzo, Louis
AU - Glassberg, Robert
AU - Pass, Harvey
AU - Endress, Carmen
AU - Yoder, Mark
AU - Shah, Palmi
AU - Welch, Laura
AU - Kalafer, Michael
AU - Green, Jeremy
AU - Walsh, James
AU - Bertsch, David
AU - Camacho, Elmer
AU - Chin, Cynthia
AU - O'Brien, James
AU - Willey, James C.
N1 - Funding Information: This report was sponsored by the Simons Foundation . Funding Information: Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest.This report was sponsored by the Simons Foundation. Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest. Publisher Copyright: © 2019 International Association for the Study of Lung Cancer Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/5
Y1 - 2019/5
N2 - Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.
AB - Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.
KW - Lung cancer survival
KW - Lymphatic
KW - Pleural
KW - Small lung cancers
KW - Vascular invasion
UR - http://www.scopus.com/inward/record.url?scp=85063202185&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063202185&partnerID=8YFLogxK
U2 - 10.1016/j.jtho.2019.01.013
DO - 10.1016/j.jtho.2019.01.013
M3 - Article
C2 - 30685507
AN - SCOPUS:85063202185
VL - 14
SP - 890
EP - 902
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
SN - 1556-0864
IS - 5
ER -