The prognosis and treatment consideration for non-small cell lung carcinoma patients with tumor size of >2.0-3.0 cm and visceral pleural invasion: a SEER-based study.

BACKGROUND

Lung cancer is the most prevailing oncological disease worldwide. Visceral pleural invasion (VPI) has been proven to be a poor prognosis factor for early-stage non-small cell lung carcinoma (NSCLC) patients. However, there remains some debate regarding whether NSCLC patients with tumor size (TS) ranging from >2.0 to 3.0 cm and VPI should be considered for postoperative treatment. This study compared the prognosis of T2a and T2b NSCLC patients, specifically focusing on those with VPI and TS ranging from >2.0-3.0 cm to emphasize the severity of the disease. Additionally, the impact of adjuvant therapies on the outcome of these patients was discussed.

METHODS

This retrospective research utilized data from the Surveillance, Epidemiology, and End Results (SEER) database, which provided a comprehensive dataset of 10,452 patients diagnosed with pN0M0 NSCLC with TS intervals of >2.0-5.0 cm between 2010 and 2019. The SEER database, renowned for its expansive and population-based cancer data, provides a robust platform for researchers to access a large cohort of patients diagnosed with NSCLC. Survival probabilities were calculated by the Kaplan-Meier method and compared between groups with Log-rank test. Univariate and multivariate logistic analyses were used to identify independent risk factors of VPI.

RESULTS

Patients with NSCLC and TS between >2.0 and 3.0 cm, along with VPI, had a worse 5-year overall survival rate compared to those at T2a stage (49.1% 56.8%, P=0.03) and T2b stage (45.4% 64.2%, P<0.0001). However, no statistical significance was observed when comparing patients with TS range between >2.0 and 3.0 cm and presenting with VPI to those staged T2b and received adjuvant chemotherapy (48.4% 48.5%, P=0.54). Patients with clinical stage of T1c and VPI positive had significantly better prognosis after receiving chemotherapy (34.5% 55.2%, P<0.001). Logistic analysis indicated that age older than 65 years old, poor differentiated and undifferentiated, as well as sub-lobectomy resection were independent risk factors for VPI in NSCLC.

CONCLUSIONS

Postoperative chemotherapy can improve the prognosis of patients with TS ranging from >2.0 to 3.0 cm with VPI. According to the analysis of OS based on the postoperative chemotherapy, patients with NSCLC featuring TS extend from >2.0 to 3.0 cm and VPI may be classified within stage IIA. Consequently, the consideration of postoperative chemotherapy for this patient cohort may be warranted.