Visible Pleural Retraction is a Prognostic Marker in Early-Stage Non-Small Cell Lung Cancer: A Retrospective Cohort...

Visceral pleural invasion (VPI) has been established as a significant prognostic factor in non-small cell lung cancer (NSCLC), which affects decisions on surgery method; however, there are currently no effective ways to confirm VPI in a timely manner. We hypothesized that visible pleural retraction (VPR) may correlate with VPI and share similar prognostic significance, thereby providing real-time guidance for surgical decision making. This study aimed to evaluate the prognostic value of VPR.

This retrospective cohort study included NSCLC patients with a tumor diameter ≤2 cm who underwent radical surgery. Survival analyses were performed to compare recurrence-free survival (RFS) and overall survival (OS) among patients with different VPI and VPR statuses. Multivariable Cox regression was conducted to identify independent risk factors for poor prognosis.

Overall, 2033 patients were included, of whom 215 (10.6%) had VPI and 578 (28.4%) had VPR. The median follow-up time was 48.1 months. Patients with VPR had significantly worse RFS and OS compared with those without VPR (hazard ratio [HR] 4.91, 95% confidence interval [CI] 2.69-8.97, p < 0.001; and HR 7.44, 95% CI 3.35-16.55, p < 0.001, respectively). Among patients with VPR, there were no significant differences in RFS or OS based on the presence or absence of VPI (HR 0.99, 95% CI 0.44-2.22, p = 0.99; and HR 0.96, 95% CI 0.38-2.40, p = 0.90). Multivariate Cox regression analysis certified that VPR is an independent risk factor for both poor RFS and OS (HR 6.57, 95% CI 3.28-13.17, p < 0.001; and HR 8.817, 95% CI 3.51-22.16, p < 0.001, respectively).

VPR is a reliable timely prognostic marker in T≤2cmN0M0 NSCLC, and the prognostic value of VPR is independent of VPI status.