CHEST Guidelines-Modification-of-Pathologic-T-Classification-for-No

Modification-of-Pathologic-T-Classification-for-No

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The study explores the reclassification of non-small cell lung cancer (NSCLC) T categories under 3 cm with visceral pleural invasion (VPI), focusing on whether tumors with PL1 should be considered T2 instead of T1. Researchers evaluated 1,055 cases of NSCLC, confirming VPI status using both hematoxylin and eosin (H&E) staining and Victoria blue elastic stain. <br /><br />VPI was categorized as PL0 (no invasion), PL1 (invasion beyond the elastic layer), and PL2 (invasion into the pleural surface). Five-year disease-free survival (DFS) and overall survival (OS) rates were measured. Results showed that PL2 cases had significantly worse DFS and OS compared to PL0 and PL1, whereas PL0 and PL1 had comparable outcomes. Hence, they proposed that PL1 tumors remain T1, indicating that individuals with node-negative NSCLC and PL1 might not require the heightened stage designation and subsequent adjuvant chemotherapy typically associated with T2 cases.<br /><br />The study's findings suggest that reclassifying PL1 tumors from T2 to T1 could prevent overtreatment with chemotherapy, traditionally considered for advanced stages, thereby sparing certain patients unnecessary treatment. The proposal for modifying the T classification aligns with the interest in making the staging more accurate and reflective of actual survival outcomes, proposing that additional aggressive treatment might not benefit PL1 lung cancer patients as previously thought.<br /><br />Elastic staining was reaffirmed as a critical tool for accurate VPI determination. The study also highlighted that confounding variables like lymph node metastases impact survival, which must be considered in prognosis evaluations for NSCLC. Notably, the study was retrospective and from a single institution, suggesting that broader studies are required for validation.

Keywords

NSCLC

visceral pleural invasion

T category reclassification

PL1 tumors

elastic staining

disease-free survival

overall survival

chemotherapy overtreatment

lymph node metastases

retrospective study