Significance of Spread Through Air Spaces in Resected Pathological Stage I Lung Adenocarcinoma

Toyokawa, Gouji; Yamada, Yuichi; Tagawa, Tetsuzo; Kozuma, Yuka; Matsubara, Taichi; Haratake, Naoki; Takamori, Shinkichi; Akamine, Takaki; Oda, Yoshinao; Maehara, Yoshihiko

doi:10.1016/j.athoracsur.2018.01.037

Cited by 90 publications

(101 citation statements)

References 25 publications

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“…Furthermore, STAS was significantly associated with malignant pathological characteristics, such as advanced tumor stage, lower histological differentiation, and the presence of pleural invasion. This result is also consistent with previous reports of STAS, and collectively, this evidence suggests that lung adenocarcinomas with STAS might be potentially malignant.…”

Section: Discussionsupporting

confidence: 93%

“…in 2015, similar concepts, including aerogenous spread with floating cancer cell clusters and tumor islands, have been reported . Although the definite mechanisms of STAS have yet to be elucidated, several studies have shown an association with male gender, a history of smoking, and clinicopathologically invasive features, such as larger tumor diameter, the presence of pleural invasion, and histologically invasive types …”

Section: Introductionmentioning

confidence: 81%

“…[7][8][9] Although the definite mechanisms of STAS have yet to be elucidated, several studies have shown an association with male gender, a history of smoking, and clinicopathologically invasive features, such as larger tumor diameter, the presence of pleural invasion, and histologically invasive types. 6,[10][11][12] Regarding the role of STAS as a significant prognostic factor, several reports have shown the negative impact of STAS on postoperative survival of resected NSCLC patients. 6,[11][12][13][14][15][16] Particularly in early-stage lung adenocarcinomas, STAS is reported to be a prognostic factor in patients who have undergone limited resection, but not lobectomy.…”

Section: Introductionmentioning

confidence: 99%

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Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

et al. 2018

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BackgroundIn early‐stage lung adenocarcinomas, spread through air spaces (STAS) are reported to be a prognostic factor in patients who have undergone sublobar resection, but not lobectomy. In contrast, reports have also shown that STAS is significantly associated with poor survival outcomes after lobectomy, but not after limited resection. Thus, the prognostic impact of STAS differs according to published reports.MethodsA total of 82 patients with early‐stage adenocarcinomas who underwent limited resection and whose STAS status could be examined were enrolled in this retrospective study. We evaluated the association between STAS and clinicopathological characteristics and postoperative survival.ResultsAmong 82 patients, 31 (37.8%) were positive for STAS, while 51 (62.2%) were negative. STAS was significantly associated with advanced tumor stage (P < 0.01), lower histological differentiation (P = 0.01), and the presence of pleural invasion (P = 0.01). Patients with STAS had significantly shorter recurrence‐free survival (RFS) and overall survival (OS) than those without STAS (P < 0.01 and P = 0.02, respectively). According to multivariate analysis, positivity for STAS was an independent prognostic parameter for RFS (P < 0.01), but not OS (P = 0.45). Three patients who developed surgical margin recurrence and one patient who developed distant recurrence were all positive for STAS.ConclusionsSTAS was predictive of poor postoperative survival in patients with early‐stage adenocarcinomas treated with limited resection and was associated with surgical margin recurrence.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

et al. 2018

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“…All five reports demonstrated positive correlation of STAS to aggressive pathologic factors including high grade subtypes, pleural invasion, and lymphovascular invasion. Of note, four of five studies showed prognostic significance in patients treated with lobectomy . A wide range of occurrence of STAS may suggest difficulty in STAS diagnosis.…”

Section: Introductionmentioning

confidence: 95%

“…Thus, we reviewed the occurrence of STAS and prognostic significance in only pathologic stage I lung adenocarcinoma, focusing on studies with over 100 patients. As shown in Table , five reports have documented the prognostic significance of STAS in pathologic stage I lung ADC . The incidence of STAS ranged from 15% to 56% in pathologic stage I lung ADC.…”

Section: Introductionmentioning

confidence: 99%

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

et al. 2019

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Recently, the incidence of small, peripheral lung adenocarcinoma has been increasing as lung cancer screening with radiologic examination is more widely performed. Tumor size is one of the determinants of the prognostic outcome in clinically node‐negative lung adenocarcinoma. Sublobar resection has been proposed as one of the minimally invasive surgical options for small‐sized adenocarcinomas. Despite the lack of robust clinical trial evidence, sublobar resection has become more popular, especially in developed countries where less extensive surgery may be of benefit in a population where the age of the elderly is growing. However, high risk histologic features such as micropapillary subtype and tumor spread through air space (STAS) have been associated with a significantly higher risk of local recurrence after sublobar resection, but not after lobectomy. Surgical decision‐making based on frozen section diagnosis of high risk histologic features may be useful to prevent local control failure after sublobar resection. At the present time, there is little evidence to demonstrate the diagnostic accuracy of identifying high risk histologic features on frozen section. One study has so far demonstrated that diagnostic accuracy of identifying STAS is higher than that of identifying the micropapillary subtype. Additionally, the presence of STAS has been found to be more strongly associated with local recurrence in patients who had undergone sublobar resection. Although further investigation is required for validation of this finding, STAS diagnosis on frozen section may shed further light on intraoperative surgical decision‐making during sublobar resection. To this end, we review the recently published data on the intraoperative identification of high risk features.

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Prognostic impact of tumor spread through air spaces for T2aN0 stage IB non‐small cell lung cancer

Chen,

Wu,

Fang

et al. 2023

Cancer Medicine

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BackgroundSpread through air spaces (STAS) is a pattern of invasion recently identified in non‐small cell lung cancer (NSCLC), with a poor prognosis. However, the predictive impact of STAS in stage IB NSCLC is not well understood. This investigation aims to assess the prognostic influence of STAS in stage IB NSCLC.MethodsWe reviewed 130 resected stage IB NSCLC between 2010 and 2015. Beyond the central tumor edge, lung parenchymal air gaps containing cancer cells were identified as STAS. In order to estimate recurrence‐free survival (RFS) and overall survival (OS), Cox models and Kaplan–Meier techniques were utilized. Logistic regression analysis was employed to define the factors influencing STAS.ResultsOf 130 patients, 72 (55.4%) had STAS. STAS was a significant prognosticator. Kaplan–Meier method showed that STAS‐positive patients had a significantly lower OS and RFS than STAS‐negative patients (5‐year OS, 66.5% vs. 90.4%, p = 0.02; 5‐year RFS, 59.5% vs. 89.7%, p = 0.004) In a semiquantitative assessment, the RFS and OS were shorter in survival analysis when STAS increased (5‐year RFS, 89.7%, no STAS, 61.8%, low STAS, 57.2%, high STAS, p = 0.013; 5‐year OS, 90.4%, no STAS, 78.3%, low STAS, 57.2%, high STAS, p = 0.002). The association between STAS and poor differentiation, adenocarcinoma, and vascular invasion (p value was <0.001, 0.047, and 0.041, respectively) was statistically significant.ConclusionsThe STAS is an aggressive pathological feature. RFS and OS could be significantly reduced by STAS, while it also serves as an independent predictor.

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Significance of Spread Through Air Spaces in Resected Pathological Stage I Lung Adenocarcinoma

Cited by 90 publications

References 25 publications

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

Prognostic impact of tumor spread through air spaces for T2aN0 stage IB non‐small cell lung cancer

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