Cancer Res Treat.  2019 Oct;51(4):1540-1548. 10.4143/crt.2019.057.

Clinical Significance of Pleural Attachment and Indentation of Subsolid Nodule Lung Cancer

Affiliations
  • 1Department of Internal Medicine, Armed Forces Daegu Hospital, Gyeongsan, Korea.
  • 2Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine and Respiratory Center, Seoul National University Bundang Hospital, Seongnam, Korea. ctlee@snu.ac.kr
  • 3Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 5Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 6Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

PURPOSE
Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of pleural attachment and/or indentation on visceral pleural invasion (VPI) and recurrence-free survival.
MATERIALS AND METHODS
Patients who underwent curative resection of lung cancer as subsolid nodules from April 2007 to January 2016 were retrospectively evaluated. They were divided into four groups according to their relationship with the pleura. Clinical, radiographical, and pathological findings were analyzed.
RESULTS
Among 404 patients with malignant subsolid nodule, 120 (29.7%) had neither pleural attachment nor indentation, 26 (6.4%) had attachment only, 117 (29.0%) had indentation only, and 141 (34.9%) had both. VPI was observed in nodules of 36 patients (8.9%), but absent in nonsolid nodules and in those without pleural attachment and/or indentation. Compared to subsolid nodules with concurrent pleural attachment and indentation, those with attachment only (odds ratio, 0.12; 95% confidence interval [CI], 0.02 to 0.98) and indentation only (odds ratio, 0.10; 95% CI, 0.03 to 0.31) revealed lower odds of VPI. On subgroup analysis, the size of the solid portion was associated with VPI among those with pleural attachment and indentation (p=0.021). Such high-risk features for VPI were associated with earlier lung cancer recurrence (adjusted hazard ratio, 3.31; 95% CI, 1.58 to 6.91).
CONCLUSION
Concurrent pleural attachment and indentation are risk factors for VPI, and the odds increase with larger solid portion in subsolid nodules. Considering the risk of recurrence, early surgical resection could be encouraged in these patients.

Keyword

Lung neoplasms; Non-small-cell lung carcinoma; Pleura; Neoplasm invasiveness; Prognosis

MeSH Terms

Carcinoma, Non-Small-Cell Lung
Humans
Lung Neoplasms*
Lung*
Neoplasm Invasiveness
Pleura
Prognosis
Recurrence
Retrospective Studies
Risk Factors

Figure

  • Fig. 1. Radiographic examples of subsolid nodules. (A, B) Without pleural attachment nor indentation. (C, D) With pleural attachment, but without indentation. (E, F) With indentation, but without pleural attachment. (G, H) With both pleural attachment and indentation.

  • Fig. 2. Effect of pleural attachment and indentation on recurrence-free survival of subsolid lung adenocarcinoma. A, attachment; I, indentation.


Reference

References

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65:87–108.
Article
2. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015; 385:977–1010.
Article
3. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365:395–409.
Article
4. Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS, et al. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol. 2002; 178:1053–7.
5. Nakamura S, Fukui T, Kawaguchi K, Fukumoto K, Hirakawa A, Yokoi K. Does ground glass opacity-dominant feature have a prognostic significance even in clinical T2aN0M0 lung adenocarcinoma? Lung Cancer. 2015; 89:38–42.
Article
6. Ujiie H, Kadota K, Chaft JE, Buitrago D, Sima CS, Lee MC, et al. Solid predominant histologic subtype in resected stage I lung adenocarcinoma is an independent predictor of early, extrathoracic, multisite recurrence and of poor postrecurrence survival. J Clin Oncol. 2015; 33:2877–84.
Article
7. Seok Y, Lee E. Visceral pleural invasion is a significant prognostic factor in patients with partly solid lung adenocarcinoma sized 30 mm or smaller. Thorac Cardiovasc Surg. 2018; 66:150–5.
8. Kadota K, Nitadori J, Sima CS, Ujiie H, Rizk NP, Jones DR, et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas. J Thorac Oncol. 2015; 10:806–14.
Article
9. Lu S, Tan KS, Kadota K, Eguchi T, Bains S, Rekhtman N, et al. Spread through Air Spaces (STAS) is an independent predictor of recurrence and lung cancer-specific death in squamous cell carcinoma. J Thorac Oncol. 2017; 12:223–34.
Article
10. Hsu JS, Han IT, Tsai TH, Lin SF, Jaw TS, Liu GC, et al. Pleural tags on CT scans to predict visceral pleural invasion of non-small cell lung cancer that does not abut the pleura. Radiology. 2016; 279:590–6.
Article
11. Ahn SY, Park CM, Jeon YK, Kim H, Lee JH, Hwang EJ, et al. Predictive CT features of visceral pleural invasion by T1-sized peripheral pulmonary adenocarcinomas manifesting as subsolid nodules. AJR Am J Roentgenol. 2017; 209:561–6.
Article
12. Zhao LL, Xie HK, Zhang LP, Zha JY, Zhou FY, Jiang GN, et al. Visceral pleural invasion in lung adenocarcinoma ≤ 3 cm with ground-glass opacity: a clinical, pathological and radiological study. J Thorac Dis. 2016; 8:1788–97.
13. Zwirewich CV, Vedal S, Miller RR, Muller NL. Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation. Radiology. 1991; 179:469–76.
Article
14. Ko JP, Suh J, Ibidapo O, Escalon JG, Li J, Pass H, et al. Lung adenocarcinoma: correlation of quantitative CT findings with pathologic findings. Radiology. 2016; 280:931–9.
Article
15. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016; 11:39–51.
16. Travis WD, Giroux DJ, Chansky K, Crowley J, Asamura H, Brambilla E, et al. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2008; 3:1213–23.
Article
17. Seki N, Fujita Y, Shibakuki R, Seto T, Uematsu K, Eguchi K. Easier understanding of pleural indentation on computed tomography. Intern Med. 2007; 46:2029–30.
Article
18. Shimada Y, Yoshida J, Hishida T, Nishimura M, Ishii G, Nagai K. Predictive factors of pathologically proven noninvasive tumor characteristics in T1aN0M0 peripheral non-small cell lung cancer. Chest. 2012; 141:1003–9.
Article
19. Meniga IN, Tiljak MK, Ivankovic D, Aleric I, Zekan M, Hrabac P, et al. Prognostic value of computed tomography morphologic characteristics in stage I non-small-cell lung cancer. Clin Lung Cancer. 2010; 11:98–104.
Article
20. Zhang H, Lu C, Lu Y, Yu B, Lv F, Zhu Z. The predictive and prognostic values of factors associated with visceral pleural involvement in resected lung adenocarcinomas. Onco Targets Ther. 2016; 9:2337–48.
Article
21. Bak SH, Lee HY, Kim JH, Um SW, Kwon OJ, Han J, et al. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest. 2016; 149:180–91.
Article
22. Jiang L, Liang W, Shen J, Chen X, Shi X, He J, et al. The impact of visceral pleural invasion in node-negative non-small cell lung cancer: a systematic review and meta-analysis. Chest. 2015; 148:903–11.
23. Huang H, Wang T, Hu B, Pan C. Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer. Ann Thorac Surg. 2015; 99:1130–9.
Article
24. Liu QX, Deng XF, Zhou D, Li JM, Min JX, Dai JG. Visceral pleural invasion impacts the prognosis of non-small cell lung cancer: a meta-analysis. Eur J Surg Oncol. 2016; 42:1707–13.
Article
25. Hattori A, Suzuki K, Matsunaga T, Takamochi K, Oh S. Visceral pleural invasion is not a significant prognostic factor in patients with a part-solid lung cancer. Ann Thorac Surg. 2014; 98:433–8.
26. Antony VB, Sahn SA, Mossman B, Gail DB, Kalica A. NHLBI workshop summaries. Pleural cell biology in health and disease. Am Rev Respir Dis. 1992; 145:1236–9.
27. Yamamoto T, Kadoya N, Shirata Y, Koto M, Sato K, Matsushita H, et al. Impact of tumor attachment to the pleura measured by a pretreatment CT image on outcome of stage I NSCLC treated with stereotactic body radiotherapy. Radiat Oncol. 2015; 10:35.
Article
28. Wang H, Schabath MB, Liu Y, Berglund AE, Bloom GC, Kim J, et al. Semiquantitative computed tomography characteristics for lung adenocarcinoma and their association with lung cancer survival. Clin Lung Cancer. 2015; 16:e141–63.
Article
29. Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology. 2013; 266:304–17.
Article
30. Wang T, Zhou C, Zhou Q. Extent of visceral pleural invasion affects prognosis of resected non-small cell lung cancer: a meta-analysis. Sci Rep. 2017; 7:1527.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr