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 1 2019 |
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Keywords
- Lung cancer survival
- Lymphatic
- Pleural
- Small lung cancers
- Vascular invasion
ASJC Scopus subject areas
- Oncology
- Pulmonary and Respiratory Medicine
Cite this
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, 01.05.2019, p. 890-902.Research output: Contribution to journal › Article
}
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.
PY - 2019/5/1
Y1 - 2019/5/1
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 -