Visceral pleural invasion classification in non-small-cell lung cancer in the 7th edition of the tumor, node, metastasis classification for lung cancer: Validation analysis based on a large-scale nationwide database

Akikazu Kawase, Junji Yoshida, Etsuo Miyaoka, Hisao Asamura, Yoshitaka Fujii, Yoichi Nakanishi, Kenji Eguchi, Masaki Mori, Noriyoshi Sawabata, Meinoshin Okumura, Kohei Yokoi

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42 Citations (Scopus)

Abstract

OBJECTIVE: In the 7th tumor, node, metastasis (TNM) classification, visceral pleural invasion (VPI) is defined as invasion beyond the elastic layer, including invasion to the visceral pleural surface, and T1 tumors with VPI are upgraded to T2a. To validate this, we analyzed the survival of non-small-cell lung cancer patients from a nationwide database and evaluated the prognostic impact of VPI. METHODS: The clinicopathological characteristics and prognosis of 4995 patients who were included in the registry study of the Japanese Joint Committee of Lung Cancer Registry were retrospectively analyzed with a special interest in the prognostic impact of VPI. These patients underwent surgery in 2004 and were pathologically staged as T1a-3N0. VPI was defined as including PL1 and PL2 according to the 7th TNM Classification, but the Japanese Joint Committee of Lung Cancer Registry did not collect data regarding staining or how extensively VPI was evaluated in each participating institution. RESULTS: The survival differences were statistically significant between PL0 and PL1, PL1 and PL2, as well as PL2 and T3. There were no significant survival differences between T1a with VPI and T1b without VPI, or between T1a with VPI and T2a without VPI. There were no significant survival differences between T1b with VPI and T2a without VPI, or between T1b with VPI and T2b without VPI. There were no significant survival differences between T2a with VPI and T2b without VPI, or between T2b with VPI and T2b without VPI. T3 showed significantly worse prognosis than T2a with VPI and T2b with VPI. CONCLUSIONS: In addition to the current TNM classification recommendations, in which T1 tumors with VPI are upgraded to T2a, T2a tumors with VPI should be classified as T2b.

Original languageEnglish
Pages (from-to)606-611
Number of pages6
JournalJournal of Thoracic Oncology
Volume8
Issue number5
DOIs
Publication statusPublished - 2013 May
Externally publishedYes

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Keywords

  • NSCLC
  • TNM classification
  • visceral pleural invasion

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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