Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma

Abstract

Among stage I lung adenocarcinoma patients, spread through air spaces was found frequently in the invasive cases and was closely related to poor prognosis and recurrence.

Spread through air spaces (STAS): a comprehensive update

“…More interestingly, the authors demonstrate that the presence of a micropapillary component together with STAS results in a shift of the T stage compared to the same tumors without both features being present. In a further validation study STAS was confirmed as an independent prognostic parameter in multivariate analysis for both overall and recurrence-free survival (11). In a series of 544 ADC with a validation cohort of 541 patients, those with ADCs 3 cm or smaller and STAS had worse recurrence-free and overall survival than those without STAS.…”

“…Another recent study concerning STAS in a series of 318 stage I ADC confirmed and extended the yet available data. The authors found significant associations of STAS with the male sex, the median CEA level, smoking status, median maxSUV, solid nodules on computed tomography, p-stage, EGFR wild-type, lymphovascular invasion, and pleural invasion (11). In a series of 209 ADC where the authors aimed to quantify STAS there were statistically significant associations between higher STAS and solid predominant ADC, pleural invasion, lymphatic invasion, vascular invasion, and tumor size ≥10 mm (13).…”

“…One may argue that the strong correlation of STAS with lymphovascular invasion is causative for the locoregional and distant recurrence. However, yet available studies demonstrated that STAS was a significant prognosticator independent of lymphovascular invasion (1,11). So if the prognostic impact and the high association with locoregional recurrence cannot be fully explained by lymphovascular invasion, STAS occurring in situ seems to be the only logic alternative.…”

Tumor spread through air spaces (STAS): a call for more evidence

“…Second, the initial study also suggested that STAS is a significant risk factor for locoregional and distant recurrence in patients who underwent limited resection, but not in those underwent lobectomy (4). Nevertheless, several recently published studies, including ours, have proved that the presence of STAS is closely related to reduced recurrencefree survival (RFS) and overall survival (OS) even in patients who underwent lobectomy (7,8). The largest case series consisting of more than 1,000 early stage ADCs (≤2 cm) has also confirmed that patients without STAS had better survival outcomes than those with STAS independent of resection type (lobectomy or limited resection) (9).…”

Spread through air spaces (STAS): prognostic impact of a semi-quantitative assessment

“…The authors found significant associations of STAS with the male sex, the median CEA level, smoking status, median maxSUV, solid nodules on computed tomography, p-stage, EGFR wild-type, lymphovascular invasion, and pleural invasion (11). In the series by Uruga et al where STAS was semi-quantitatively analyzed in 208 stage I ADC there were statistically significant associations between higher STAS and solid predominant ADC, pleural invasion, lymphatic invasion, vascular invasion, and tumor size ≥10 mm (4).…”