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. 2024 Jul;19(7):1028-1051.
doi: 10.1016/j.jtho.2024.03.015. Epub 2024 Mar 18.

The International Association for the Study of Lung Cancer (IASLC) Staging Project for Lung Cancer: Recommendation to Introduce Spread Through Air Spaces as a Histologic Descriptor in the Ninth Edition of the TNM Classification of Lung Cancer. Analysis of 4061 Pathologic Stage I NSCLC

William D Travis  1 , Megan Eisele  2 , Katherine K Nishimura  2 , Rania G Aly  3 , Pietro Bertoglio  4 , Teh-Ying Chou  5 , Frank C Detterbeck  6 , Jessica Donnington  7 , Wentao Fang  8 , Philippe Joubert  9 , Kemp Kernstine  10 , Young Tae Kim  11 , Yolande Lievens  12 , Hui Liu  13 , Gustavo Lyons  14 , Mari Mino-Kenudson  15 , Andrew G Nicholson  16 , Mauro Papotti  17 , Ramon Rami-Porta  18 , Valerie Rusch  19 , Shuji Sakai  20 , Paula Ugalde  21 , Paul Van Schil  22 , Chi-Fu Jeffrey Yang  23 , Vanessa J Cilento  2 , Masaya Yotsukura  24 , Hisao Asamura  25 ; Members of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Members of the Advisory Boards, and Participating Institutions of the Lung Cancer Domain
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Free article

The International Association for the Study of Lung Cancer (IASLC) Staging Project for Lung Cancer: Recommendation to Introduce Spread Through Air Spaces as a Histologic Descriptor in the Ninth Edition of the TNM Classification of Lung Cancer. Analysis of 4061 Pathologic Stage I NSCLC

William D Travis et al. J Thorac Oncol. 2024 Jul.
Free article

Abstract

Introduction: Spread through air spaces (STAS) consists of lung cancer tumor cells that are identified beyond the edge of the main tumor in the surrounding alveolar parenchyma. It has been reported by meta-analyses to be an independent prognostic factor in the major histologic types of lung cancer, but its role in lung cancer staging is not established.

Methods: To assess the clinical importance of STAS in lung cancer staging, we evaluated 4061 surgically resected pathologic stage I R0 NSCLC collected from around the world in the International Association for the Study of Lung Cancer database. We focused on whether STAS could be a useful additional histologic descriptor to supplement the existing ones of visceral pleural invasion (VPI) and lymphovascular invasion (LVI).

Results: STAS was found in 930 of 4061 of the pathologic stage I NSCLC (22.9%). Patients with tumors exhibiting STAS had a significantly worse recurrence-free and overall survival in both univariate and multivariable analyses involving cohorts consisting of all NSCLC, specific histologic types (adenocarcinoma and other NSCLC), and extent of resection (lobar and sublobar). Interestingly, STAS was independent of VPI in all of these analyses.

Conclusions: These data support our recommendation to include STAS as a histologic descriptor for the Ninth Edition of the TNM Classification of Lung Cancer. Hopefully, gathering these data in the coming years will facilitate a thorough analysis to better understand the relative impact of STAS, LVI, and VPI on lung cancer staging for the Tenth Edition TNM Stage Classification.

Keywords: Histologic descriptor; Lung cancer; Lymphovascular invasion; Spread through air spaces; Stage classification; Visceral pleural invasion.

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Conflict of interest statement

Disclosure Dr. Donington reports receiving personal fees from Amgen, AstraZeneca, Bristol Myers Squibb, Merck & Co., Inc., and Genentech, Inc./F. Hoffmann-La Roche Ltd., outside the submitted work. Dr. Joubert reports grants from AstraZeneca, Roche, Merck and Biomark Signature Inc. and personal fees from AstraZeneca and Merck, outside the submitted work. Dr. Mino-Kenudson reports receiving personal fees from AstraZeneca, Pfizer, Repare, Sanofi, AbbVie, Daiichi Sankyo, Boehringer Ingelheim, and Elsevier, outside the submitted work. Dr. Nishimura reports receiving grants from IASLC, outside the submitted work. Dr. Nicholson reports receiving personal fees from Merck, Boehringer Ingelheim, Novartis, AstraZeneca, Bristol Myers Squibb, Roche, AbbVie, Oncologica, UpToDate, the European Society of Oncology, Liberum, Takeda UK, and Sanofi and grants and personal fees from Pfizer, outside the submitted work. Dr. Papotti reports receiving personal fees from Roche, Eli Lilly, AstraZeneca, and Pfizer, outside the submitted work. Dr. Ugalde Figueroa reports receiving personal fees from AstraZeneca, Bristol, Roche, Medtronic, and Johnson & Johnson, outside the submitted work. Dr. Van Schil reports receiving personal fees from AstraZeneca, Bristol Myers Squibb, Merck Sharp & Dohme, Roche, and Janssen, outside the submitted work; and serving as President of International Association for the Study of Lung Cancer and Treasurer of Belgian Association for Cardiothoracic Surgery. Dr. Yang reports being on advisory boards for AstraZeneca and Genentech. He has also received honorarium from AstraZeneca, outside the submitted work. Dr. Lievens reports financing from the EU ImmunoSABR project, personal fees from the UpLung project, Astra-Zeneca, outside the submitted work.

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