title: 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.
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.
authors.affiliation: Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Akikazu
authors.initials: A
authors.lastname: Kawase
authors.forename: Junji
authors.initials: J
authors.lastname: Yoshida
authors.forename: Etsuo
authors.initials: E
authors.lastname: Miyaoka
authors.forename: Hisao
authors.initials: H
authors.lastname: Asamura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fujii
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.forename: Meinoshin
authors.initials: M
authors.lastname: Okumura
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology* / Q000601:surgery; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult