Visceral pleural invasion (VPI), an aggressive and invasive factor, may have an impact on survival in node-negative non-small cell lung cancer (NSCLC), according to an article published in Chest.1

Investigators conducted a meta-analysis with 13 relevant studies that included 27,171 patients with node-negative NSCLC, and 21% had VPI. VPI had a significant impact on 5-year overall survival (OS) in patients with tumor size ≤3 cm (odds ratio [OR], 0.71: 95% CI, .64-.79; P<.001), >3 but ≤5 cm (OR, .69; 95% CI, .56-.86; P<.001), and >5 but ≤7 cm (OR, .70; 95% CI, .54-.91; P=.007).

When compared to stage 1B NSCLC, tumor size ≤3 cm plus VPI displayed improved survival over tumor size >3 but ≤5 cm independent of VPI presence (OR, 1.31; 95% CI, 1.19-1.45; P<.001).

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In an exploratory analysis, tumor size ≤3 cm plus VPI did not possess a significant OS benefit over tumor size >3 but ≤5 cm without VPI (OR, 1.16; 95% CI, .95-1.43; P=.15) but was associated with a better prognosis.

Authors concluded that because VPI and tumor size can synergistically impact survival in node-negative NSCLC, adjuvant chemotherapy after surgical resection may be considered in patients with stage 1B NSCLC. Additional clinical trials are required to investigate this further.


  1. Long J, Liang W, Shen 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(4):903-911.