Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Rowena Yip, Teng Ma, Raja M. Flores, David Yankelevitz, Claudia I. Henschke, David F. Yankelevitz, Mary Salvatore, Raja Flores, Andrea Wolf, Mildred Chen, Daniel M. Libby, James P. Smith, Mark Pasmantier, A. P. Reeves, Steven Markowitz, Albert Miller, Jose Cervera Deval, Heidi Roberts, Demetris Patsios, Shusuke SoneTakaomi Hanaoka, Javier Zulueta, Juan P. de-Torres, Maria D. Lozano, Ralph Aye, Kristin Manning, Thomas Bauer, Stefano Canitano, Salvatore Giunta, Enser Cole, Karl Klingler, John H.M. Austin, Gregory D.N. Pearson, Dorith Shaham, Cheryl Aylesworth, Patrick Meyers, Shahriyour Andaz, Davood Vafai, David Naidich, Georgeann McGuinness, Barry Sheppard, Matthew Rifkin, M. Kristin Thorsen, Richard Hansen, Samuel Kopel, William Mayfield, Dan Luedke, Donald Klippenstein, Alan Litwin, Peter A. Loud, Leslie J. Kohman, Ernest M. Scalzetti, Richard Thurer, Nestor Villamizar, Arfa Khan, Rakesh Shah, Xueguo Liu, Gary Herzog, Diana Yeh, Ning Wu, Joseph Lowry, Carmine Frumiento, David S. Mendelson, Michael V. Smith, Robert Korst, Jana Taylor, Michelle S. Ginsberg, Michaela Straznicka, Mark Widmann, Gary Cecchi, Terence A.S. Matalon, Paul Scheinberg, Shari Lynn Odzer, David Olsen, Fred Grannis, Arnold Rotter, Daniel Ray, David Mullen, Peter H. Wiernik, Edson H. Cheung, Melissa Lim, Louis DeCunzo, Robert Glassberg, Harvey Pass, Carmen Endress, Mark Yoder, Palmi Shah, Laura Welch, Michael Kalafer, Jeremy Green, James Walsh, David Bertsch, Elmer Camacho, Cynthia Chin, James O'Brien, James C. Willey

Research output: Contribution to journalArticle

5 Scopus citations

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 languageEnglish (US)
Pages (from-to)890-902
Number of pages13
JournalJournal of Thoracic Oncology
Volume14
Issue number5
DOIs
StatePublished - 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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