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% vs. 56.8%, P=0.03) and T2b stage (45.4% vs. 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% vs. 48.5%, P=0.54). Patients with clinical stage of T1c and VPI positive had significantly better prognosis after receiving chemotherapy (34.5% vs. 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.