You can make changes, but you have to publish them. (!= the sources of your application)
With commercial there is also bundled a support from Nokia.3) I include a copy of the LGPL license/a link to the Qt source along with my app
So basically, the only benefits I see of having a commercial license are that I can link statically and that I can freely modify the Qt source to my heart's content without having to distribute anything else.
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