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. 2021 Jan 1;32(1):64-72.
doi: 10.1093/icvts/ivaa227.

Clinical implication of tumour spread through air spaces in pathological stage I lung adenocarcinoma treated with lobectomy

Eunjue Yi  1 , Jeong Hyeon Lee  2 , Younggi Jung  1 , Jae Ho Chung  1 , Youngseok Lee  2 , Sungho Lee  1
Affiliations

Clinical implication of tumour spread through air spaces in pathological stage I lung adenocarcinoma treated with lobectomy

Eunjue Yi et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: The aim of this study was to evaluate the clinical implication of tumour spread through air spaces (STAS) as a prognostic factor in pathological stage I lung adenocarcinoma treated with lobectomy and to identify related parameters.

Methods: Medical records of patients who underwent pulmonary lobectomy for stage I (American Joint Committee on Cancers eighth edition) lung adenocarcinomas between 2012 and February 2018 at our institutions were reviewed retrospectively. Patients with minimally invasive adenocarcinomas and tumours ≥3 cm in size were excluded. Included patients were classified into STAS (+) and STAS (-) groups. Clinical implications of STAS and recurrence in patients were investigated.

Results: A total of 109 patients was analysed: 41 (37.6%) in the STAS (+) and 68 (62.4%) in the STAS (-) group. STAS was associated with larger consolidation diameter on chest tomography (≥1.5 cm; P = 0.006) or a higher invasive ratio (≥85%; P = 0.012) and presence of a micropapillary pattern in multivariable analysis (P = 0.003) The recurrence-free survival curve showed statistical difference (P = 0.008) with 3-year survival rates of 73.0% (9 patients) and 96.8% (2 patients) in the STAS (+) and STAS (-) group, respectively. However, no statistical significance was observed in the lung cancer-related survival curve (P = 0.648). The presence of STAS was an independent risk factor for recurrence in multivariable analysis (hazard ratio = 5.9, P = 0.031).

Conclusions: The presence of STAS could be an important risk factor for recurrence in patients with early-stage invasive lung adenocarcinoma treated with pulmonary lobectomy.

Keywords: Invasive adenocarcinoma; Lobectomy; Prognosis.

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Figures

Figure 1:
Figure 1:
Pathological findings of spread through air spaces (STAS). (A) High-power field image (×100) of lung adenocarcinoma. Tumour margin and normal alveolar spaces are observed. (B) STAS adjacent to the edge of tumours (red arrow). STAS are defined as (i) micropapillary structures consisting without central fibrovascular cores, (ii) solid nests or tumour island filing air spaces, and (iii) single cells consisting of scattered discohesive single cells. (C) STAS found within air spaces in the lung parenchyma beyond the edge of the main tumour (yellow arrow).
Figure 2:
Figure 2:
Recurrence-free and overall survival curves of STAS (+) and STAS (−) groups. (A) Recurrence-free survival curve in any place. (B) Recurrence-free survival curve related with loco-regional recurrence. (C) Recurrence-free survival curve related with distant metastasis. (D) Overall survival curve. (E) Lung cancer-related overall survival. Number of patients with recurrence and mortality was described in Supplementary Material, D3. Results of Kaplan–Meier survival analysis with log-rank tests were described in Supplementary Material, D5. STAS: spread through air spaces.
None
See this image and copyright information in PMC

References

    1. Lee JS, Kim EK, Kim M, Shim HS. Genetic and clinicopathologic characteristics of lung adenocarcinoma with tumor spread through air spaces. Lung Cancer 2018;123:121–6. - PubMed
    1. Onozato ML, Kovach AE, Yeap BY, Morales-Oyarvide V, Klepeis VE, Tammireddy S et al. Tumor islands in resected early stage lung adenocarcinomas are associated with unique clinicopathological and molecular characteristics and worse prognosis. Am J Surg Pathol 2013;37:287–94. - PMC - PubMed
    1. Cao D, Sha J, Cui R, Han S. Advances in research of spreading through air spaces and the effects on the prognosis of lung cancer. Cancer Manag Res 2019;11:9725–32. - PMC - PubMed
    1. Kadota K, Nitadori JI, Sima CS, Ujiie H, Rizk NP, Jones DR et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas. J Thorac Oncol 2015;10:806–14. - PMC - PubMed
    1. Masai K, Sakurai H, Sukeda A, Suzuki S, Asakura K, Nakagawa K et al. Prognostic impact of margin distance and tumor spread through air spaces in limited resection for primary lung cancer. J Thorac Oncol 2017;12:1788–97. - PubMed

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