Objective: To determine long‐term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan‐Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11–20 mm, and 21–30 mm) and nodule consistency. Log‐rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan‐Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01–1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25–7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10‐fold (HR = 10.06, 95% CI: 1.35–75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01–5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01–1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.

中文翻译：

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肺实质和胸膜浸润小于 30 毫米的非小细胞肺癌的存活率

目的：确定脏层胸膜浸润 (VPI) 和实质浸润 (PAI)（血管淋巴管和/或血管）对最大直径小于 30 mm 的 NSCLC 生存率的长期生存率。方法：针对按病理肿瘤大小（≤10 毫米、11-20 毫米和 21-30 毫米）和结节分层的前瞻性筛查参与者队列，确定 NSCLC 的 Kaplan-Meier 生存率，有或没有 VPI 和/或 PAI。一致性。计算对数秩检验统计量。结果：亚实性结节患者 PAI 与 VPI 的发生率显着低于实性结节患者（4.9% 与 27.7% [p < 0.0001]），相应地，Kaplan-Meier 肺癌患者的生存率显着高于实性结节患者。亚实性结节（99.1% 与 91.3% [p = 0.0009]）。多变量 Cox 回归发现只有肿瘤直径（调整后的风险比 [HR] = 1.07，95% 置信区间 [CI]：1.01-1.14，p = 0.02）和 PAI（调整后的 HR = 3.15，95% CI：1.25-7.90， p = 0.01）仍然显着，而 VPI 不显着（p = 0.15）。当病理结果包括临床和计算机断层扫描结果时，Cox 回归显示，对于实性结节及更多的非小细胞肺癌患者，肺癌死亡风险增加了 10 倍（HR = 10.06，95% CI：1.35-75.30）中度至重度肺气肿（HR = 2.27, 95% CI: 1.01–5.11）以及肿瘤直径增加（HR = 1.06, 95% CI: 1.01–1.13）的患者增加两倍（2.27倍） ，而 PAI 不再显着（p = 0.19）。结论：计算机断层扫描结节的一致性是比 PAI 或 VPI 更重要的预后指标。我们建议 VPI 和最大肿瘤直径为 30 mm 或以下的 NSCLC 患者不升级至 T2，除非进一步对 NSCLC 进行大型、多中心研究，根据新的 T 状态进行分层，并且对于亚实性或实性患者应单独考虑分类结节。