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

Background: 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.

Methods: 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.

Results: 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).

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