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. 2025;31(1):25-00100.
doi: 10.5761/atcs.oa.25-00100.

The Presence of Both Tumor Spread through Air Spaces and Visceral Pleural Invasion May Increase Tumor Recurrence Risk in Non-Small Cell Lung Cancer

Joshua R Brady  1 , Brittany Walker  1 , Jocelyn C Zajac  1 , Daniel P McCarthy  2 , James D Maloney  2 , Malcolm M DeCamp  2 , Andrea L Axtell  2
Affiliations

The Presence of Both Tumor Spread through Air Spaces and Visceral Pleural Invasion May Increase Tumor Recurrence Risk in Non-Small Cell Lung Cancer

Joshua R Brady et al. Ann Thorac Cardiovasc Surg. 2025.

Abstract

Purpose: Tumor spread through air spaces (STAS) and visceral pleural invasion (VPI) are negative prognostic factors in lung cancer. However, it is unknown whether they have a compounding prognostic effect. Therefore, we analyzed the association between STAS and VPI with overall survival and recurrence.

Methods: A retrospective cohort analysis was conducted on 421 adult patients who underwent pulmonary resection for non-small cell lung cancer at an academic institution between 2018 and 2022. Baseline characteristics were compared between patients who had STAS only, VPI only, or both STAS and VPI. Overall survival and cumulative recurrence were compared using the Kaplan-Meier method.

Results: Of the 421 patients who underwent a pulmonary resection, 34 (8%) had both STAS and VPI. Their combined presence was associated with increased smoking pack-years, increased tumor size, and an increased presence of lymphovascular invasion. There was no overall survival difference (p = 0.190) between patients with both STAS and VPI and those with only one feature or neither. However, cumulative incidence of recurrence was increased (p = 0.001) for patients with both.

Conclusion: The presence of STAS and VPI was not associated with decreased overall survival; however, their combined presence may have a compounding effect on recurrence risk.

Keywords: adenocarcinoma of lung; carcinoma; lung neoplasms; non-small cell lung.

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Conflict of interest statement

DPM serves as a consultant to AtriCure and Cook Medical Inc. MMD serves as a consultant to Pulmonex. The remaining authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1. Overall survival. (A) Entire cohort stratified by the presence or absence of VPI. (B) Entire cohort stratified by the presence or absence of STAS. (C) Entire cohort stratified by the presence of only STAS, only VPI, neither, or both features. (D) Stage I disease stratified by the presence of only STAS, only VPI, neither, or both features.
STAS: tumor spread through air spaces; VPI: visceral pleural invasion.
Fig. 2
Fig. 2. Cumulative incidence of recurrence. (A) Entire cohort stratified by the presence or absence of VPI. (B) Entire cohort stratified by the presence or absence of STAS. (C) Entire cohort stratified by the presence of only STAS, only VPI, neither, or both features. (D) Stage I disease stratified by the presence of only STAS, only VPI, neither, or both features.
STAS: tumor spread through air spaces; VPI: visceral pleural invasion.
See this image and copyright information in PMC

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