Background: Visceral pleural invasion (VPI) has traditionally been regarded as a negative prognostic indicator in non-small-cell lung cancer (NSCLC). However, with the increasing adoption of sublobar resection for small-sized NSCLC, the clinical significance of VPI is being fundamentally reassessed. Specifically, it remains uncertain whether VPI is indicative of tumor size or represents distinct metastatic behavior. Methods: We conducted a retrospective comprehensive multicenter study involving 2464 patients with pathologically confirmed NSCLC ≤ 3 cm who underwent complete resection at three Japanese institutions. The prevalence, metastatic patterns, and prognostic impact of VPI were systematically evaluated, with particular focus on histological growth patterns. Results: VPI was identified in 370 patients (15%). Notably, VPI-positive tumors demonstrated a doubled incidence of lymph node metastasis (31% vs. 15%,p< 0.001) and a distinct metastatic profile characterized by preferential hilar spread (#12, 16.9%) and an increased risk of skip N2 metastasis (4.0% vs. 2.0%). Five-year recurrence-free survival was significantly reduced in the VPI group (33.7% vs. 50.6%, respectively). Conversely, adenocarcinomas with lepidic characteristics demonstrated a minimal risk of VPI or nodal metastasis, with incidences of 2% and 1%, respectively. This finding highlights the heterogeneity in the biological aggressiveness of small-sized NSCLC. Conclusions: Our findings suggest that VPI is not merely a histopathological descriptor but also acts as a clinically significant indicator of aggressive metastatic behavior, potentially enhancing surgical and staging approaches beyond just considering tumor size. With the increasing adoption of sublobar resection for small-sized NSCLC, recognizing that VPI appears to be associated with predominant hilar involvement and an elevated risk of skip N2 metastasis may help refine decisions on the extent of lung and lymph node resection.
背景：在非小细胞肺癌（NSCLC）中，脏层胸膜侵犯（VPI）传统上被视为不良预后指标。然而，随着针对小型NSCLC的亚肺叶切除术日益普及，VPI的临床意义正在被重新审视。具体而言，目前尚不确定VPI是反映肿瘤大小的指标，还是代表独特的转移行为。 方法：我们开展了一项回顾性多中心综合研究，纳入了来自日本三家机构的2464例经病理证实、肿瘤直径≤3 cm且接受完全切除的NSCLC患者。系统评估了VPI的发生率、转移模式及其对预后的影响，并特别关注组织学生长模式。 结果：370例患者（15%）存在VPI。值得注意的是，VPI阳性肿瘤的淋巴结转移发生率翻倍（31% vs. 15%，p < 0.001），并表现出独特的转移特征，包括偏好肺门转移（#12站，16.9%）以及跳跃性N2转移风险增加（4.0% vs. 2.0%）。VPI组的5年无复发生存率显著降低（分别为33.7% vs. 50.6%）。相反，具有贴壁样特征的腺癌发生VPI或淋巴结转移的风险极低，发生率分别为2%和1%。这一发现凸显了小型NSCLC在生物学侵袭性方面的异质性。 结论：我们的研究结果表明，VPI不仅仅是一个组织病理学描述指标，更是一个具有临床意义的侵袭性转移行为指标，其潜在价值可能超越单纯考虑肿瘤大小，有助于优化手术和分期策略。随着针对小型NSCLC的亚肺叶切除术日益普及，认识到VPI似乎与主要的肺门受累及跳跃性N2转移风险升高相关，可能有助于完善关于肺组织和淋巴结切除范围的决策。
肿瘤(癌症)患者之家