Visceral pleural invasion (VPI) is considered an important prognostic factor in non-small cell lung cancer (NSCLC). If a tumor shows VPI it increases the T-stage, even for tumors less than 30 mm in diameter, from stage IA to stage IB. However, the prognostic significance of VPI in early-stage lung cancer with a gross-glass-like (GGO) presentation is controversial. Qin Jianjun, Department of Thoracic Surgery, Henan Cancer Hospital To evaluate the effect of VPI on the prognosis of patients with lymph node-negative NSCLC, Dr. AritoshiHattori et al. at the School of Medicine, Suntory University, Japan, studied this issue and found that VPI may have no effect on the prognosis of some NSCLC patients with solid nodes. The article was published in a recent issue of ATS. The study collected a total of 466 patients with surgically resected stage N0 NSCLC less than 30 mm in diameter from 2004 to 2012. These patients were classified as partially solid and solid using thin-section CT scans. These patients were retrospectively analyzed and factors affecting prognosis were evaluated using a Cox proportional risk model. Figure 1: Typical images of VPI in partially solid lung cancer on thin-layer CT scans. 237 patients (55%) showed partial solidity and 209 patients (45%) showed solidity on thin-layer CT scans. 24 (10%) patients with partially solid nodules and 79 (38%) patients with solid nodules showed VPI. Based on multifactorial analysis, VPI was not a major prognostic factor in patients with partially solid nodules (p=0.5902). The 5-year survival rate was 85.6% and 94.9% for patients presenting with and without VPI in the partial solid group, respectively (p=0.3798). In contrast, VPI, vascular invasion, maximum tumor diameter, and carcinoembryonic antigen levels were significant prognostic factors in solid nodes (p=0.0211, 0.0188, 0.0372, and 0.0492). Moreover, the 5-year survival rate was lower (p=0.0051) in patients with combined VPI in solid nodules (70.1%) than in those without combined VPI (81.3%). Figure 2: Survival curves for patients with partial solid lung cancer less than 30 mm in diameter. The 5-year survival rates were 85.6% and 94.9% for patients presenting and not presenting VPI, respectively (p=0.3798) Figure 3: Survival curves for patients with solid lung cancer less than 30 mm in diameter. The 5-year survival rates for the presence and absence of pleural invasion were 81.3% and 70.1%, respectively; p=0.0051 The above results show that VPI has significant predictive value for the prognosis of solid small volume lung cancer, but not for the prognosis of patients with non-solid lung cancer. Therefore, for lung cancer with GGO as the main manifestation if VPI is present, TNM staging and postoperative chemotherapy should not be upgraded.