Visceral pleura invasion and lung cancer: further clarifications

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Abstract
Kang et al. [1] reported that visceral pleura invasion (VPI) was a factor of poor prognosis in T2 non-small cell lung cancer (NSCLC). In a previous study [2], we already stressed the poor prognosis of VPI which we also found correlated with more extensive mediastinal lymph node (LN) involvement and decreased survival rates. Contrary to these authors, we observed VPI to be more frequent in case of non-squamous carcinoma (and of adenosquamous carcinoma which others also underline [3]) and in tumours larger than 5 cm. Concerning this latter point there is an unclear area in their paper. In the ‘patient and method’ section, they took into account T2 lesions and in the results they provide lesions measuring more or less than 3 cm. In case of T2 lesions, VPI is present in 100% of tumours 3 cm or less, the tumours without VPI being T1. Perhaps the authors meant 5 cm and this was mistyped: in such case they must add the T1N0 subgroup to the T2 without VPI. The frequency of VPI will probably appear higher for tumours more than 5 cm.

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