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Meta-Analysis
. 2022 Apr;13(7):997-1005.
doi: 10.1111/1759-7714.14348. Epub 2022 Feb 17.

The prognostic significance of tumor spread through air space in stage I lung adenocarcinoma

Liling Huang  1 , Le Tang  1 , Liyuan Dai  2 , Yuankai Shi  1
Affiliations
Meta-Analysis

The prognostic significance of tumor spread through air space in stage I lung adenocarcinoma

Liling Huang et al. Thorac Cancer. 2022 Apr.

Abstract

Aim: There are still patients of stage I lung adenocarcinoma (ADC) suffering from local or distant recurrence. Herein we conducted a meta-analysis to investigate the prognostic value of tumor spread through air space (STAS), a new form of invasion pattern, in patients with pathologically confirmed stage I lung ADC.

Methods: Related literature was searched using PubMed, Embase, Cochrane Library, and Web of Science databases from the inception dates to September 4, 2021. Recurrence-free survival (RFS) and overall survival (OS) were set as primary outcome endpoints. In addition, subgroup analyses on operation mode, edition of the American Joint Committee on Cancer TNM staging, sample size, and research regions were also investigated.

Results: A total of 17 studies involving 9785 patients were included. The presence of STAS was detected in 31.2% of patients and was associated with poor RFS (adjusted hazard ratio [HR] = 1.93, p < 0.001) and OS (HR = 2.02, p < 0.001). In subgroup analysis on operation mode, the prognostic value of STAS was prominently shown in patients who underwent limited resection (RFS: HR = 3.58, p < 0.001; OS: HR = 3.37, p < 0.001), while for patients who underwent lobectomy, adverse impact of STAS on RFS was observed (HR = 1.60, p = 0.019), but no significant difference was observed on OS (HR = 1.56, p = 0.061). The results fluctuated in different regions while other factors did not alter the independent predictive value of STAS.

Conclusion: Tumor STAS should be considered as an adverse prognostic indicator for patients with stage I lung ADC, especially for those under limited resection. More intensive medical care for those patients needs to be investigated in further studies.

Keywords: lung adenocarcinoma; meta-analysis; prognosis; spread through air space.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flow diagram of included studies
FIGURE 2
FIGURE 2
Meta‐analysis of the association between tumor spread through air space and recurrence‐free survival. (a) Forest plot of meta‐analysis in the whole population. (b) Forest plot of meta‐analysis in the subgroup of limited resection and lobectomy. (c) Filled funnel plot using the “trim‐and‐fill” method. Dark circles indicate observed studies, hollow circles in squares indicate missed studies. (d) Sensitivity analysis in the whole population. (e) Sensitivity analysis in the subgroup of limited resection. (f) Sensitivity analysis in subgroup of lobectomy
FIGURE 3
FIGURE 3
Meta‐analysis of the association between tumor spread through air space and overall survival. (a) Forest plot of meta‐analysis in the whole population. (b) Forest plot of meta‐analysis in the subgroup of limited resection and lobectomy. (c) Sensitivity analysis in the whole population. (d) Sensitivity analysis in the subgroup of limited resection. (e) Sensitivity analysis in the subgroup of lobectomy
See this image and copyright information in PMC

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