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. 2022 Jun 1;34(6):1011-1015.
doi: 10.1093/icvts/ivab289.

Prognostic impact of spread through air spaces in lung adenocarcinoma

Sara Mantovani  1 , Angelina Pernazza  2 , Massimiliano Bassi  1 , Davide Amore  1 , Jacopo Vannucci  1 , Camilla Poggi  1 , Daniele Diso  1 , Giulia d'Amati  3 , Carlo Della Rocca  3 , Erino Angelo Rendina  1 , Federico Venuta  1 , Marco Anile  1
Affiliations

Prognostic impact of spread through air spaces in lung adenocarcinoma

Sara Mantovani et al. Interact Cardiovasc Thorac Surg. .

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.

Keywords: Adenocarcinoma; Lymph node involvement; Pulmonary resections; STAS.

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Figures

Figure 1:
Figure 1:
(A) Example of a tumour with low spread through air spaces: only 1 solid nest of neoplastic cells (circle) is detectable in the alveolar spaces beyond the edge of the tumour (haematoxylin and eosin, 10×). (B) Example of a tumour with high spread through air spaces: multiple micropapillary clusters are present beyond the edge of the tumour (dashed line) (haematoxylin and eosin, 10×).
Figure 2:
Figure 2:
Kaplan–Meier curves of sublobar and major resections in patients N0 spread through air spaces-positive compared by the log-rank test (P = 0.04).
None
See this image and copyright information in PMC

References

    1. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB et al.; WHO Panel. The 2015 WHO classification of lung tumors. Impact of genetic, clinical and radiological advances from 2004. J Thorac Oncol 2015;10:1243–60. - PubMed
    1. Kadota K, Nitadori J, Sima CS, Ujiie H, Rizk NB, Jones DR et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences following limited resection for small stage I lung adenocarcinoma. J Thorac Oncol 2015;10:806–14. - PMC - PubMed
    1. Blaauwgeers H, Russell PA, Jones KD, Radonic T, Thunnissen E. Pulmonary loose tumor tissue fragments and spread through air spaces (STAS): invasive pattern or artifact? A critical review. Lung Cancer 2018;123:107–11. - PubMed
    1. Toyokawa G, Yamada Y, Tagawa T, Oda Y. Significance of spread through air spaces in early-stage lung adenocarcinomas undergoing limited resection. Thorac Cancer 2018;9:1255–61. - PMC - PubMed
    1. Wart A, Muley T, Kossakowski CA, Goeppert B, Schirmacher P, Dienemann H et al. Prognostic impact of intra-alveolar tumor spread in pulmonary adenocarcinoma. Am J Surg Pathol 2015;39:793–801. - PubMed