In an analysis from the CALGB 140503 trial reported in JAMA Oncology, Nasser Altorki, MD, and colleagues found that pathologically identified visceral pleural invasion was associated with poorer outcomes in patients undergoing surgery for non–small cell lung cancer (NSCLC).
Study Details
The trial included 697 patients with small peripheral NSCLC clinically staged as T1N0 who were randomly assigned to undergo lobar or sublobar resection. After a median follow-up of 7 years, the primary outcome of disease-free survival after sublobar resection was noninferior to that after lobar resection.
The current analysis assessed outcomes in patients with tumors pathologically upstaged to T2 on the basis of visceral pleural invasion (pT2) compared with those who had pathologic T1 (pT1) tumors.
Key Findings
Among the total of 697 patients, 566 (81.2%) had pT1 tumors (no visceral pleural invasion), and 113 (16.2%) had tumors upstaged to pT2 (visceral pleural invasion).
The 5-year disease-free survival rate was 65.9% (95% confidence interval [CI] = 61.9%–70.2%) in patients with pT1 tumors vs 53.3% (95% CI = 44.3%–64.1%) in patients with pT2 tumors (P = .02).
Disease recurrence developed in 27.6% of patients with pT1 tumors vs 41.6% of those with pT2 tumors, with locoregional recurrence occurring in 10.8% vs 15.0% and distant recurrence occurring in 14.6% vs 23.9%. The 5-year recurrence-free survival rate was 73.1% (95% CI = 69.2%–77.1%) among patients with pT1 tumors vs 58.2% (95% CI = 49.2%–68.8%) among those with pT2 tumors (P = .01).
No significant differences in disease-free or recurrence-free survival were observed between patients with pT1 vs pT2 tumors according to the extent of parenchymal resection.
The investigators concluded: “The results of this secondary analysis suggest that compared with patients with tumors without visceral pleural invasion, patients who had tumors with visceral pleural invasion had worse disease-free and recurrence-free survival and a higher rate of local and distant disease recurrence. These high rates of recurrence were independent of the extent of parenchymal resection, and these data support the inclusion of these patients in adjuvant therapy trials.”
Dr. Altorki, of Weill Cornell Medicine–New York Presbyterian Hospital, is the corresponding author of the JAMA Oncology article.
Disclosure: The study was supported by grants from the National Cancer Institute and by Covidien/Tyco/Ethicon. For full disclosures of the study authors, visit jamanetwork.com.
