Prognostic Impact of Tumor Spread Through Air Spaces in Sublobar Resection for 1A Lung Adenocarcinoma Patients

Ren, Yijiu; Xie, Huikang; Dai, Chenyang; She, Yunlang; Su, Hang; Xie, Dong; Zheng, Hui; Zhang, Liping; Jiang, Gening; Wu, Chunyan; Chen, Chang

doi:10.1245/s10434-019-07296-w

Cited by 49 publications

(52 citation statements)

References 25 publications

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“…STAS tends to have a more significant impact on the prognosis of stage I ADC patients who underwent sublobar or limited resection. 1,24,26,40 Meanwhile, in stage I ADC with STAS, sublobar/limited resection was associated with a significantly higher risk of recurrence than lobectomy was, and similar results were observed in LC-CID. However, there was no significant difference in CIR between lobectomy and sublobar/limited resection in patients without STAS.…”

Section: The Influence Of Stas On Surgical Extentmentioning

confidence: 53%

<p>Spread Through Air Spaces (STAS) in Lung Cancer: A Multiple-Perspective and Update Review</p>

Meng¹,

Yu²,

Gao³

et al. 2020

CMAR

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Background: Spread through air spaces (STAS) is a spreading phenomenon of lung cancers, which is defined as tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor. To date, several articles have reviewed the studies concerning the significance of STAS; however, most articles focused on the prognosis without summarizing the significance of STAS on other aspects. In this review, we comprehensively summarized the current literature related to STAS, so as to explore the clinical significance of STAS from multiple perspectives. Main Body: This section provided a comprehensive overview of the significance of STAS from multiple perspectives and summarized current controversies and challenges in the diagnosis and clinical application. Conclusion: STAS is a conspicuous spreading phenomenon of lung cancers indicating worse prognosis; nevertheless, the treatment strategy for patients with STAS remains to be discussed. Further studies are needed to elaborate whether a STAS-positive patient who underwent limited resection needs a second operation or postoperative adjuvant treatment. Meanwhile, the internal mechanism of STAS formation is largely undiscovered. Whether the capability of detachment-migration-reattachment in STAS tumor cells is achieved at the time of primary tumorigenesis or in the progress of tumor development needs to be studied, and the related signal pathways or genetic alterations need to be explored. With this information, it may be possible to improve the prognosis of patients with STAS-positive lung cancers.

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Section: The Influence Of Stas On Surgical Extentmentioning

confidence: 53%

<p>Spread Through Air Spaces (STAS) in Lung Cancer: A Multiple-Perspective and Update Review</p>

Meng¹,

Yu²,

Gao³

et al. 2020

CMAR

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“…Further, tumor cells which spread through air spaces (STAS), a newly described pattern of invasion, is defined as tumor cells extending beyond the tumor edge within the lung parenchyma, has been reported to be a significant risk factor for local recurrence after sublobar resection . More recently, STAS was shown to be significantly associated with a poor prognosis in patients who had undergone sublobar resection, but not in patients who had undergone lobectomy in stage IA lung ADC . In addition, some reports demonstrated that the presence of STAS is a unfavorable prognostic factor in lung ADC patients who had underwent lobar resection as well and shows significant relationship to aggressive clinicopathological characteristics (e.g., larger tumor size, nodal metastasis, higher pathologic stage, pleural invasion, and vessel invasion) as well as immunohistochemical features .…”

Section: Introductionmentioning

confidence: 99%

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

et al. 2019

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Recently, the incidence of small, peripheral lung adenocarcinoma has been increasing as lung cancer screening with radiologic examination is more widely performed. Tumor size is one of the determinants of the prognostic outcome in clinically node‐negative lung adenocarcinoma. Sublobar resection has been proposed as one of the minimally invasive surgical options for small‐sized adenocarcinomas. Despite the lack of robust clinical trial evidence, sublobar resection has become more popular, especially in developed countries where less extensive surgery may be of benefit in a population where the age of the elderly is growing. However, high risk histologic features such as micropapillary subtype and tumor spread through air space (STAS) have been associated with a significantly higher risk of local recurrence after sublobar resection, but not after lobectomy. Surgical decision‐making based on frozen section diagnosis of high risk histologic features may be useful to prevent local control failure after sublobar resection. At the present time, there is little evidence to demonstrate the diagnostic accuracy of identifying high risk histologic features on frozen section. One study has so far demonstrated that diagnostic accuracy of identifying STAS is higher than that of identifying the micropapillary subtype. Additionally, the presence of STAS has been found to be more strongly associated with local recurrence in patients who had undergone sublobar resection. Although further investigation is required for validation of this finding, STAS diagnosis on frozen section may shed further light on intraoperative surgical decision‐making during sublobar resection. To this end, we review the recently published data on the intraoperative identification of high risk features.

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“…Since 2018, a few studies have discussed the significance of STAS based on the 8th edition AJCC/UICC staging system, and the reported results mainly focused on ADC [7][8][9][10][11][12][13][14][15]. Some attention has been paid to the significance of STAS in stage I patients; however, few studies analyzed the significance of STAS in other stages exclusively.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive analysis of spread through air spaces in lung adenocarcinoma and squamous cell carcinoma using the 8th edition AJCC/UICC staging system

Meng

et al. 2020

BMC Cancer

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Background: This study aimed to comprehensively investigate the effect of spread through air spaces (STAS) on clinicopathologic features, molecular characteristics, immunohistochemical expression, and prognosis in lung adenocarcinomas (ADC) and squamous cell carcinomas (SQCC) based on the 8th edition AJCC/UICC staging system. Methods: In total, 303 ADC and 121 SQCC cases were assessed retrospectively. Immunohistochemical staining was performed for E-cadherin, vimentin, Ki67, survivin, Bcl-2, and Bim. Correlations between STAS and other parameters were analyzed statistically. Results: STAS was observed in 183 (60.4%) ADC and 39 (32.2%) SQCC cases. In ADC, the presence of STAS was associated with wild-type EGFR, ALK and ROS1 rearrangements, low E-cadherin expression, and high vimentin and Ki67 expression. In SQCC, STAS was associated with low E-cadherin expression and high vimentin and survivin expression. Based on univariate analysis, STAS was associated with significantly shorter disease-free survival (DFS) and overall survival (OS) in ADC. In SQCC, STAS tended to be associated with shorter OS. By multivariate analysis, STAS was an independent poor prognostic factor in ADC for DFS but not OS. Stratified analysis showed that STAS was correlated with shorter DFS for stage I, II, IA, IB, and IIA ADC based on univariate analysis and was an independent risk factor for DFS in stage I ADC cases based on multivariate analysis. Conclusions: Our findings revealed that STAS is an independent negative prognostic factor for stage I ADC using the new 8th edition AJCC/UICC staging system. Stage I patients with STAS should be followed up more closely and might need different treatment strategies.

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Prognostic Impact of Tumor Spread Through Air Spaces in Sublobar Resection for 1A Lung Adenocarcinoma Patients

Cited by 49 publications

References 25 publications

<p>Spread Through Air Spaces (STAS) in Lung Cancer: A Multiple-Perspective and Update Review</p>

<p>Spread Through Air Spaces (STAS) in Lung Cancer: A Multiple-Perspective and Update Review</p>

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

Comprehensive analysis of spread through air spaces in lung adenocarcinoma and squamous cell carcinoma using the 8th edition AJCC/UICC staging system

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