Novel Biologic Risk Factors of Visceral Pleural Invasion in Early Non-Small Cell Lung Cancer Less Than 3cm

Han-Yu Deng, Gang Li, Yi-Dan Li

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

Objective:Visceral pleural invasion (VPI) in early non-small cell lung cancer (NSCLC) is traditionally believed as the result of too much close distance between cancerous lesion and the visceral pleura, but whether there is any other biologic factors beyond our instinctive thoughts remains unclear. Therefore, we conducted this study to investigate potential risk factors of VPI comprehensively.

Methods:Both clinical and pathologic characteristics of patients undergoing surgery for NSCLC with a size of ≤3cm were retrospectively analyzed.

Results:A total of 403 patients were included for analysis. Patients with VPI had older mean age than those without (61.1 years VS 56.1 years; P<0.001). The mean size of NSCLC with VPI was larger than those without (2.1cm VS 1.6cm; P<0.001). Moreover, NSCLC with VPI were located closer to visceral pleura (0.8cm VS 1.3cm; P<0.001) and showed larger rates of pleural indentation (86.8% VS 45.6%; P<0.001) and spiculation (59.7% VS 34.7%; P<0.001) than those without. Pathologically, NSCLC with VPI tended more likely to be adenocarcinoma (96.9% VS 92.7%; P=0.097) and was more likely to be poorly differentiated (38.0% VS 15.3%; P<0.001), to have cancer embolus (6.2% VS 0.7%; P=0.001) and lymph node metastasis (29.5% VS10.2%; P<0.001) than those without. Apart from Shorter distance to visceral pleura (OR=2.169, 95%CI: 1.221-3.855; P=0.008), older age (Odds ratio (OR)=2.119, 95% confidence interval (CI): 1.255-3.503; P=0.005), pleural indentation (OR= 3.679, 95%CI: 1.888-7.169; P<0.001), adenocarcinoma (OR=4.741, 95%CI: 1.383-16.255; P=0.013), and poor tumor differentiation (OR=11.816, 95%CI:4.470-31.234; P<0.001) were also independent risk factors of VPI in early NSCLC.

Conclusions:Apart from shorter distance to visceral pleura and pleural indentation, senility, adenocarcinoma, and poor tumor differentiation were novel biologic independent predictive factors of VPI in early NSCLC.