Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer

Abstract

Background: The prognostic effect of visceral pleural invasion remains controversial when a tumor is less than 3 cm in stage I non-small cell lung cancer patients. We conducted this meta-analysis to evaluate the prognostic impact of visceral pleural invasion in these early patients.

Methods: We searched PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure and included published studies on the prognostic significance of visceral pleural invasion in stage I non-small cell lung cancer. Meta-analysis was performed and heterogeneity and publication bias were also evaluated.

Results: Twenty-two studies were included in the meta-analysis. In all stage I patients, visceral pleural invasion was associated with death (hazard ratio1.427; p = 0.000) and recurrence (hazard ratio1.600; p = 0.000). In subgroup analyses, visceral pleural invasions were consistently associated with death in each tumor size subgroup and recurrence in tumor less than 3 cm subgroup. Publication bias was not found.

Conclusions: Visceral pleural invasion is a size-independent poor prognostic factor in stage I non-small cell lung cancer patients. We suggest adjuvant treatment should be considered in stage I patients with visceral pleural invasion.