title: The predictive and prognostic values of factors associated with visceral pleural involvement in resected lung adenocarcinomas.
abstract: BACKGROUND
  The predictive and prognostic impact of factors associated with visceral pleural invasion (VPI) on survival and recurrence in patients with resected lung adenocarcinomas is not clearly defined.
  
  
  METHODS
  A total of 505 consecutive patients with stage Ia-IIIa lung adenocarcinomas treated with radical resection were included. The predominant growth pattern was classified according to the new classification system for lung adenocarcinoma proposed by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. The correlations of VPI with clinical and pathologic parameters were analyzed.
  
  
  RESULTS
  The incidence of VPI was significantly lower in lepidic predominant group (15.5% vs 4.5%, P<0.001) and higher in solid and micropapillary predominant group (28.6% vs 17.6%, P=0.004 and 14.7% vs 4.2%, P<0.001, respectively). VPI correlated with higher risk in regional postoperative recurrence (hazard ratio, 2.341; 95% confidence interval, 1.564-3.504) and distant recurrence (hazard ratio, 2.193; 95% confidence interval, 1.665-2.89) in surgically resected lung adenocarcinomas. However, when growth patterns of adenocarcinoma were lumped into multivariate analysis, VPI was not a significant independent predictive factor for survival (P=0.854 for overall survival [OS] and P=0.575 for disease-free survival [DFS]) and recurrence (P=0.38 for regional recurrence and P=0.089 for distant recurrence). Of the 95 patients with stage Ib, those who received adjuvant chemotherapy had longer DFS and OS than the patients who received no chemotherapy after surgery. However, these differences in DFS and OS did not reach statistical significance (P=0.063 for DFS, P=0.85 for OS).
  
  
  CONCLUSIONS
  VPI was associated with solid and micropapillary histology. In addition, stage Ib patients with solid histologic subtype tumor showed longer DFS and OS, highlighting a potential benefit in this subgroup of patients and necessitating the need for larger clinical trials.
authors.affiliation: Department of Thoracic Surgery, Fudan University, Shanghai, People's Republic of China.
authors.forename: Huibiao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Thoracic Surgery, Fudan University, Shanghai, People's Republic of China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Pathology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery, Fudan University, Shanghai, People's Republic of China.
authors.forename: Fanzhen
authors.initials: F
authors.lastname: Lv
authors.affiliation: Department of Thoracic Surgery, Fudan University, Shanghai, People's Republic of China.
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Zhu
keywords: TNM stage; follow-up; histologic subtype; lung cancer; visceral pleural invasion