Prognostic impact of spread through air spaces in lung adenocarcinoma

Abstract

OBJECTIVE Spread through air spaces (STAS) is a pattern of invasion present in some adenocarcinomas (ADC). The goal of this study was to assess the impact of STAS in patients treated with different types of surgical resections and on the clinical outcome in patients with ADC of different diameters and with different degrees of nodal involvement. METHODS A total of 109 patients were reviewed. Complete surgical resection with systematic nodal dissection was achieved in all patients. The median follow-up was 65 months (3–90 months). RESULTS STAS was observed in 70 cases (64.2%); 13 patients (18.5%) had lymph node involvement (N1 and N2). Overall survival and progression-free survival were higher in patients without STAS (P = 0.042; P = 0.027). The presence of STAS in tumours ≤2 cm was a predictor of worse progression-free survival following sublobar resection compared to major resections (P = 0.011). Sublobar resection of N0 STAS-positive tumours was associated with worse long-term survival compared to a major resection (P = 0.04). Statistical analyses showed that age >70 years and recurrence were independent variables for survival; smoking pack-years >20, sublobar resection and nodal involvement were independent variables for recurrence; and smoking pack-years >20 were independent variables for a history of cancer and pleural invasion for local recurrence. CONCLUSIONS STAS seems to play a role in long-term survival, particularly for patients with N0 and tumours smaller than 2 cm. Further studies are necessary to validate this hypothesis.

Role of radiomics in predicting lung cancer spread through air spaces in a heterogeneous dataset

“…STAS has gained relevance in recent years as a negative prognostic factor in patients with lung cancer, particularly ADC; it was considered an independent poor predictor of progression free survival, overall survival and lung cancer specific survival (1,2). It is present up to 64.2% of patients with lung cancer (2). Several studies examined the impact of STAS in patients undergoing sublobar resections.…”

“…Spread through air spaces (STAS) has been recently reported as a negative prognostic factor in patients with lung cancer (1,2). According to the 2015 World Health Organization classification (3), it is defined as the presence of micropapillary clusters, solid nests or single tumor cells spreading within air spaces beyond the edge of the main tumor.…”

Retrospective analysis of the prognostic implications of tumor spread through air spaces in lung adenocarcinoma patients treated with surgery

“…In the literature, it is still controversial whether sublobar resection increases the risk of locoregional recurrence compared with lobectomy in patients with STAS. 20,[37][38][39] A few studies agreed that sublobar resection was associated with higher risk of recurrence in patients with STAS, 20,36,37 whereas Kagimoto et al 40 disagreed. Taking this into account, it is reasonable to suggest that STAS-positive patients who undergo sublobar resection may potentially benefit from a completion lobectomy or adjuvant therapy to decrease the risk of recurrence.…”

“…36 There is no consensus whether sublobar resection increases the risk of locoregional recurrence compared with lobectomy in patients with STAS. 20,[36][37][38][39] A few studies suggested that sublobar resection was associated with a higher risk of recurrence in patients with stage IA and presence of STAS. 20,36,37 Kagimoto et al 40 described that prognosis after sublobar resection, however, was comparable with that of lobectomy in lung adenocarcinoma with STAS without increasing locoregional recurrence.…”

“…20,[36][37][38][39] A few studies suggested that sublobar resection was associated with a higher risk of recurrence in patients with stage IA and presence of STAS. 20,36,37 Kagimoto et al 40 described that prognosis after sublobar resection, however, was comparable with that of lobectomy in lung adenocarcinoma with STAS without increasing locoregional recurrence. Regarding adjuvant treatment, Chen et al 29 found that adjuvant chemotherapy improved outcomes in STAS-positive patients with stage IA who underwent sublobar resection.…”