Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Rowena Yip; Teng Ma; Raja M. Flores; David Yankelevitz; Claudia I. Henschke; David F. Yankelevitz; Mary Salvatore; Andrea Wolf; Mildred Chen; Daniel M. Libby; James P. Smith; Mark Pasmantier; A. P. Reeves; Steven Markowitz; Albert Miller; Jose Cervera Deval; Heidi Roberts; Demetris Patsios; Shusuke Sone; Takaomi Hanaoka; Javier Zulueta; Juan P. de-Torres; Maria D. Lozano; Ralph Aye; Kristin Manning; Thomas Bauer; Stefano Canitano; Salvatore Giunta; Enser Cole; Karl Klingler; John H.M. Austin; Gregory D.N. Pearson; Dorith Shaham; Cheryl Aylesworth; Patrick Meyers; Shahriyour Andaz; Davood Vafai; David Naidich; Georgeann McGuinness; Barry Sheppard; Matthew Rifkin; M. Kristin Thorsen; Richard Hansen; Samuel Kopel; William Mayfield; Dan Luedke; Donald Klippenstein; Alan Litwin; Peter A. Loud; Leslie J. Kohman; Ernest M. Scalzetti; Richard Thurer; Nestor Villamizar; Arfa Khan; Rakesh Shah; Xueguo Liu; Gary Herzog; Diana Yeh; Ning Wu; Joseph Lowry; Carmine Frumiento; David S. Mendelson; Michael V. Smith; Robert Korst; Jana Taylor; Michelle S. Ginsberg; Michaela Straznicka; Mark Widmann; Gary Cecchi; Terence A.S. Matalon; Paul Scheinberg; Shari Lynn Odzer; David Olsen; Fred Grannis; Arnold Rotter; Daniel Ray; David Mullen; Peter H. Wiernik; Edson H. Cheung; Melissa Lim; Louis DeCunzo; Robert Glassberg; Harvey Pass; Carmen Endress; Mark Yoder; Palmi Shah; Laura Welch; Michael Kalafer; Jeremy Green; James Walsh; David Bertsch; Elmer Camacho; Cynthia Chin; James O'Brien; James C. Willey

doi:10.1016/j.jtho.2019.01.013

Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Rowena Yip, Teng Ma, Raja M. Flores, David Yankelevitz, Claudia I. Henschke^*, David F. Yankelevitz, Mary Salvatore, Andrea Wolf, Mildred Chen, Daniel M. Libby, James P. Smith, Mark Pasmantier, A. P. Reeves, Steven Markowitz, Albert Miller, Jose Cervera Deval, Heidi Roberts, Demetris Patsios, Shusuke Sone, Takaomi HanaokaJavier Zulueta, Juan P. de-Torres, Maria D. Lozano, Ralph Aye, Kristin Manning, Thomas Bauer, Stefano Canitano, Salvatore Giunta, Enser Cole, Karl Klingler, John H.M. Austin, Gregory D.N. Pearson, Dorith Shaham, Cheryl Aylesworth, Patrick Meyers, Shahriyour Andaz, Davood Vafai, David Naidich, Georgeann McGuinness, Barry Sheppard, Matthew Rifkin, M. Kristin Thorsen, Richard Hansen, Samuel Kopel, William Mayfield, Dan Luedke, Donald Klippenstein, Alan Litwin, Peter A. Loud, Leslie J. Kohman, Ernest M. Scalzetti, Richard Thurer, Nestor Villamizar, Arfa Khan, Rakesh Shah, Xueguo Liu, Gary Herzog, Diana Yeh, Ning Wu, Joseph Lowry, Carmine Frumiento, David S. Mendelson, Michael V. Smith, Robert Korst, Jana Taylor, Michelle S. Ginsberg, Michaela Straznicka, Mark Widmann, Gary Cecchi, Terence A.S. Matalon, Paul Scheinberg, Shari Lynn Odzer, David Olsen, Fred Grannis, Arnold Rotter, Daniel Ray, David Mullen, Peter H. Wiernik, Edson H. Cheung, Melissa Lim, Louis DeCunzo, Robert Glassberg, Harvey Pass, Carmen Endress, Mark Yoder, Palmi Shah, Laura Welch, Michael Kalafer, Jeremy Green, James Walsh, David Bertsch, Elmer Camacho, Cynthia Chin, James O'Brien, James C. Willey

^*Corresponding author for this work

Center for Medical Education

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.

Original language	American English
Pages (from-to)	890-902
Number of pages	13
Journal	Journal of Thoracic Oncology
Volume	14
Issue number	5
DOIs	https://doi.org/10.1016/j.jtho.2019.01.013
State	Published - 1 May 2019

Bibliographical note

Funding Information:
This report was sponsored by the Simons Foundation .

Funding Information:
Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest.This report was sponsored by the Simons Foundation. Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest.

Publisher Copyright:
© 2019 International Association for the Study of Lung Cancer

Keywords

Lung cancer survival
Lymphatic
Pleural
Small lung cancers
Vascular invasion

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jtho.2019.01.013

Cite this

Yip, R., Ma, T., Flores, R. M., Yankelevitz, D., Henschke, C. I., Yankelevitz, D. F., Salvatore, M., Wolf, A., Chen, M., Libby, D. M., Smith, J. P., Pasmantier, M., Reeves, A. P., Markowitz, S., Miller, A., Deval, J. C., Roberts, H., Patsios, D., Sone, S., ... Willey, J. C. (2019). Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm. Journal of Thoracic Oncology, 14(5), 890-902. https://doi.org/10.1016/j.jtho.2019.01.013

@article{6ce53ef83fcf4df99499292731fb7599,

title = "Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm",

abstract = "Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.",

keywords = "Lung cancer survival, Lymphatic, Pleural, Small lung cancers, Vascular invasion",

author = "Rowena Yip and Teng Ma and Flores, {Raja M.} and David Yankelevitz and Henschke, {Claudia I.} and Yankelevitz, {David F.} and Mary Salvatore and Andrea Wolf and Mildred Chen and Libby, {Daniel M.} and Smith, {James P.} and Mark Pasmantier and Reeves, {A. P.} and Steven Markowitz and Albert Miller and Deval, {Jose Cervera} and Heidi Roberts and Demetris Patsios and Shusuke Sone and Takaomi Hanaoka and Javier Zulueta and de-Torres, {Juan P.} and Lozano, {Maria D.} and Ralph Aye and Kristin Manning and Thomas Bauer and Stefano Canitano and Salvatore Giunta and Enser Cole and Karl Klingler and Austin, {John H.M.} and Pearson, {Gregory D.N.} and Dorith Shaham and Cheryl Aylesworth and Patrick Meyers and Shahriyour Andaz and Davood Vafai and David Naidich and Georgeann McGuinness and Barry Sheppard and Matthew Rifkin and Thorsen, {M. Kristin} and Richard Hansen and Samuel Kopel and William Mayfield and Dan Luedke and Donald Klippenstein and Alan Litwin and Loud, {Peter A.} and Kohman, {Leslie J.} and Scalzetti, {Ernest M.} and Richard Thurer and Nestor Villamizar and Arfa Khan and Rakesh Shah and Xueguo Liu and Gary Herzog and Diana Yeh and Ning Wu and Joseph Lowry and Carmine Frumiento and Mendelson, {David S.} and Smith, {Michael V.} and Robert Korst and Jana Taylor and Ginsberg, {Michelle S.} and Michaela Straznicka and Mark Widmann and Gary Cecchi and Matalon, {Terence A.S.} and Paul Scheinberg and Odzer, {Shari Lynn} and David Olsen and Fred Grannis and Arnold Rotter and Daniel Ray and David Mullen and Wiernik, {Peter H.} and Cheung, {Edson H.} and Melissa Lim and Louis DeCunzo and Robert Glassberg and Harvey Pass and Carmen Endress and Mark Yoder and Palmi Shah and Laura Welch and Michael Kalafer and Jeremy Green and James Walsh and David Bertsch and Elmer Camacho and Cynthia Chin and James O'Brien and Willey, {James C.}",

note = "Funding Information: This report was sponsored by the Simons Foundation . Funding Information: Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest.This report was sponsored by the Simons Foundation. Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest. Publisher Copyright: {\textcopyright} 2019 International Association for the Study of Lung Cancer",

year = "2019",

month = may,

day = "1",

doi = "10.1016/j.jtho.2019.01.013",

language = "American English",

volume = "14",

pages = "890--902",

journal = "Journal of Thoracic Oncology",

issn = "1556-0864",

publisher = "International Association for the Study of Lung Cancer",

number = "5",

}

Yip, R, Ma, T, Flores, RM, Yankelevitz, D, Henschke, CI, Yankelevitz, DF, Salvatore, M, Wolf, A, Chen, M, Libby, DM, Smith, JP, Pasmantier, M, Reeves, AP, Markowitz, S, Miller, A, Deval, JC, Roberts, H, Patsios, D, Sone, S, Hanaoka, T, Zulueta, J, de-Torres, JP, Lozano, MD, Aye, R, Manning, K, Bauer, T, Canitano, S, Giunta, S, Cole, E, Klingler, K, Austin, JHM, Pearson, GDN, Shaham, D, Aylesworth, C, Meyers, P, Andaz, S, Vafai, D, Naidich, D, McGuinness, G, Sheppard, B, Rifkin, M, Thorsen, MK, Hansen, R, Kopel, S, Mayfield, W, Luedke, D, Klippenstein, D, Litwin, A, Loud, PA, Kohman, LJ, Scalzetti, EM, Thurer, R, Villamizar, N, Khan, A, Shah, R, Liu, X, Herzog, G, Yeh, D, Wu, N, Lowry, J, Frumiento, C, Mendelson, DS, Smith, MV, Korst, R, Taylor, J, Ginsberg, MS, Straznicka, M, Widmann, M, Cecchi, G, Matalon, TAS, Scheinberg, P, Odzer, SL, Olsen, D, Grannis, F, Rotter, A, Ray, D, Mullen, D, Wiernik, PH, Cheung, EH, Lim, M, DeCunzo, L, Glassberg, R, Pass, H, Endress, C, Yoder, M, Shah, P, Welch, L, Kalafer, M, Green, J, Walsh, J, Bertsch, D, Camacho, E, Chin, C, O'Brien, J & Willey, JC 2019, 'Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm', Journal of Thoracic Oncology, vol. 14, no. 5, pp. 890-902. https://doi.org/10.1016/j.jtho.2019.01.013

TY - JOUR

T1 - Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

AU - Yip, Rowena

AU - Ma, Teng

AU - Flores, Raja M.

AU - Yankelevitz, David

AU - Henschke, Claudia I.

AU - Yankelevitz, David F.

AU - Salvatore, Mary

AU - Wolf, Andrea

AU - Chen, Mildred

AU - Libby, Daniel M.

AU - Smith, James P.

AU - Pasmantier, Mark

AU - Reeves, A. P.

AU - Markowitz, Steven

AU - Miller, Albert

AU - Deval, Jose Cervera

AU - Roberts, Heidi

AU - Patsios, Demetris

AU - Sone, Shusuke

AU - Hanaoka, Takaomi

AU - Zulueta, Javier

AU - de-Torres, Juan P.

AU - Lozano, Maria D.

AU - Aye, Ralph

AU - Manning, Kristin

AU - Bauer, Thomas

AU - Canitano, Stefano

AU - Giunta, Salvatore

AU - Cole, Enser

AU - Klingler, Karl

AU - Austin, John H.M.

AU - Pearson, Gregory D.N.

AU - Shaham, Dorith

AU - Aylesworth, Cheryl

AU - Meyers, Patrick

AU - Andaz, Shahriyour

AU - Vafai, Davood

AU - Naidich, David

AU - McGuinness, Georgeann

AU - Sheppard, Barry

AU - Rifkin, Matthew

AU - Thorsen, M. Kristin

AU - Hansen, Richard

AU - Kopel, Samuel

AU - Mayfield, William

AU - Luedke, Dan

AU - Klippenstein, Donald

AU - Litwin, Alan

AU - Loud, Peter A.

AU - Kohman, Leslie J.

AU - Scalzetti, Ernest M.

AU - Thurer, Richard

AU - Villamizar, Nestor

AU - Khan, Arfa

AU - Shah, Rakesh

AU - Liu, Xueguo

AU - Herzog, Gary

AU - Yeh, Diana

AU - Wu, Ning

AU - Lowry, Joseph

AU - Frumiento, Carmine

AU - Mendelson, David S.

AU - Smith, Michael V.

AU - Korst, Robert

AU - Taylor, Jana

AU - Ginsberg, Michelle S.

AU - Straznicka, Michaela

AU - Widmann, Mark

AU - Cecchi, Gary

AU - Matalon, Terence A.S.

AU - Scheinberg, Paul

AU - Odzer, Shari Lynn

AU - Olsen, David

AU - Grannis, Fred

AU - Rotter, Arnold

AU - Ray, Daniel

AU - Mullen, David

AU - Wiernik, Peter H.

AU - Cheung, Edson H.

AU - Lim, Melissa

AU - DeCunzo, Louis

AU - Glassberg, Robert

AU - Pass, Harvey

AU - Endress, Carmen

AU - Yoder, Mark

AU - Shah, Palmi

AU - Welch, Laura

AU - Kalafer, Michael

AU - Green, Jeremy

AU - Walsh, James

AU - Bertsch, David

AU - Camacho, Elmer

AU - Chin, Cynthia

AU - O'Brien, James

AU - Willey, James C.

N1 - Funding Information: This report was sponsored by the Simons Foundation . Funding Information: Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest.This report was sponsored by the Simons Foundation. Disclosure: Dr. Yankelevitz reports grants from Flight Attendants Medical Research Institute, and he is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules; some of these patents, which are owned by the Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric, and as an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation that the CRF may receive from its commercialization of these patents. In addition, Dr. Yankelevitz is an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making, and he also serves on the advisory board of GRAIL. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest that are owned by the CRF. Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by the CRF. Dr. Henschke is the president of and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the foundation, which was is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients of these grants include the International Early Lung Cancer Action Program Investigators, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest. Publisher Copyright: © 2019 International Association for the Study of Lung Cancer

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.

AB - Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.

KW - Lung cancer survival

KW - Lymphatic

KW - Pleural

KW - Small lung cancers

KW - Vascular invasion

UR - http://www.scopus.com/inward/record.url?scp=85063202185&partnerID=8YFLogxK

U2 - 10.1016/j.jtho.2019.01.013

DO - 10.1016/j.jtho.2019.01.013

M3 - Article

C2 - 30685507

AN - SCOPUS:85063202185

SN - 1556-0864

VL - 14

SP - 890

EP - 902

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

IS - 5

ER -

Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Abstract

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