Prognostic value of visceral pleural invasion in the stage pT1-2N2M0 non-small cell lung cancer: A study based on the SEER registry

Curr Probl Cancer. 2021 Feb;45(1):100640. doi: 10.1016/j.currproblcancer.2020.100640. Epub 2020 Aug 17.

Abstract

Background: Visceral pleural invasion (VPI) is considered an adverse prognostic factor in non-small cell lung cancer (NSCLC). However, the prognostic roles of VPI in Ⅲ/N2 NSCLC remain controversial. Therefore, this study aims to evaluate the prognostic value of VPI in patients with postoperative stage pT1-2N2M0 NSCLC.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we screened for patients with stage T1-2N2M0 NSCLC who received surgery from 2010 to 2015. To reduce baseline differences between Non-VPI group and VPI group, two-to-one propensity score matching (PSM) was performed. Cox proportional hazards regression was used to identify factors associated with survival. Overall survival (OS) was between the Non-VPI group and the VPI+ group by the Kaplan-Meier analysis.

Results: We identified 1374 postoperative NSCLC patients with stage pT1-2N2M0. The majority of cases (N = 1047, 76.8%) are Non-VPI patients. The factors associated with VPI+ group included white race (P < 0.0001), and adenocarcinoma (P < 0.0001). When analyzed in the total study population, VPI status remained a significant independent predictor of worse OS compared with the Non-VPI group (HR, 1.343; 95% CI, 1.083-1.665 [P=0.007]). Besides, in a subgroup analysis by VPI status, the results showed that patients without treatment exhibited a higher risk level in the Non-VPI group (P<0.0001). However, we did not find statistically significant differences among treatments in the VPI+ group (P=0.199). Mean survival time was 49.5 months (95% CI: 45.7-53.3 months) for chemotherapy alone in the Non-VPI group, compared with 41.2 months (95% CI: 35.8-46.6 months) in VPI+ groups. In both the VPI group and the non-VPI group, there is no statistical difference between adjuvant chemotherapy combined with PORT and chemotherapy alone.

Conclusion: This study emphasizes that the presence of VPI is a poor prognostic factor, even in patients with Ⅲ/N2 NSCLC. As the study shows, chemotherapy significantly improved overall survival of patients with postoperative stage pT1-2N2M0 NSCLC, especially for Non-VPI patients. However, the significance of PORT is still worth further exploration.

Keywords: Non-small cell lung cancer; SEER; Visceral pleural invasion.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Carcinoma, Non-Small-Cell Lung / epidemiology*
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Chemotherapy, Adjuvant
  • Female
  • Humans
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / pathology*
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Invasiveness / pathology
  • Pleura / pathology*
  • Prognosis
  • Retrospective Studies
  • SEER Program
  • United States / epidemiology
  • Young Adult