title: Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer.
abstract: BACKGROUND
  The prognostic effect of visceral pleural invasion remains controversial when a tumor is less than 3 cm in stage I non-small cell lung cancer patients. We conducted this meta-analysis to evaluate the prognostic impact of visceral pleural invasion in these early patients.
  
  
  METHODS
  We searched PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure and included published studies on the prognostic significance of visceral pleural invasion in stage I non-small cell lung cancer. Meta-analysis was performed and heterogeneity and publication bias were also evaluated.
  
  
  RESULTS
  Twenty-two studies were included in the meta-analysis. In all stage I patients, visceral pleural invasion was associated with death (hazard ratio1.427; p = 0.000) and recurrence (hazard ratio1.600; p = 0.000). In subgroup analyses, visceral pleural invasions were consistently associated with death in each tumor size subgroup and recurrence in tumor less than 3 cm subgroup. Publication bias was not found.
  
  
  CONCLUSIONS
  Visceral pleural invasion is a size-independent poor prognostic factor in stage I non-small cell lung cancer patients. We suggest adjuvant treatment should be considered in stage I patients with visceral pleural invasion.
authors.affiliation: Department of Anesthesiology, Sichuan Cancer Hospital, Chengdu, People's Republic of China.
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Medical Oncology, Sichuan Cancer Hospital, Chengdu, People's Republic of China. Electronic address: tw19811026@163.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Medical Oncology, Sichuan Cancer Hospital, Chengdu, People's Republic of China.
authors.forename: Changchuan
authors.initials: C
authors.lastname: Pan
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden