Spread Through Air Spaces Is a Prognostic Factor in Sublobar Resection of Non-Small Cell Lung Cancer

Shiono, Satoshi; Endo, Masatoshi; Suzuki, Katsuyuki; Yarimizu, Kei; Hayasaka, Kazuki; Yanagawa, Naoki

doi:10.1016/j.athoracsur.2018.02.076

Cited by 70 publications

(74 citation statements)

References 22 publications

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“…Importantly, surgical margin recurrence was identified in three patients (3.7%) who were all positive for STAS. This result is consistent with the findings of previous studies, and a surgical margin distance < 1 cm is reported to be a risk factor for local recurrence . In addition, Morimoto et al .…”

Section: Discussionsupporting

confidence: 93%

“…In addition, Shiono et al . reported that STAS is a prognostic factor in lung cancer patients undergoing sublobar resection, although this study included non‐adenocarcinoma and pathological stages I–III . In contrast, two further reports showed that STAS is a significant prognostic factor for postoperative survival in patients with pulmonary adenocarcinomas treated with lobectomy, but not wedge resection .…”

Section: Discussionmentioning

confidence: 82%

“…6 A study also demonstrated that STAS was an independent prognostic factor of poor survival in patients with clinical stage IA lung cancer who underwent sublobar resection. 17 In contrast, another report showed that STAS was significantly associated with poor survival outcomes in patients who underwent lobectomy, but not in patients who underwent limited resection. 12 Thus, the prognostic impact of STAS in early-stage lung adenocarcinoma has yet to be definitively established.…”

Section: Introductionmentioning

confidence: 95%

“…Particularly in early‐stage lung adenocarcinomas, STAS is reported to be a prognostic factor in patients who have undergone limited resection, but not lobectomy . A study also demonstrated that STAS was an independent prognostic factor of poor survival in patients with clinical stage IA lung cancer who underwent sublobar resection . In contrast, another report showed that STAS was significantly associated with poor survival outcomes in patients who underwent lobectomy, but not in patients who underwent limited resection .…”

Section: Introductionmentioning

confidence: 99%

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Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

et al. 2018

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BackgroundIn early‐stage lung adenocarcinomas, spread through air spaces (STAS) are reported to be a prognostic factor in patients who have undergone sublobar resection, but not lobectomy. In contrast, reports have also shown that STAS is significantly associated with poor survival outcomes after lobectomy, but not after limited resection. Thus, the prognostic impact of STAS differs according to published reports.MethodsA total of 82 patients with early‐stage adenocarcinomas who underwent limited resection and whose STAS status could be examined were enrolled in this retrospective study. We evaluated the association between STAS and clinicopathological characteristics and postoperative survival.ResultsAmong 82 patients, 31 (37.8%) were positive for STAS, while 51 (62.2%) were negative. STAS was significantly associated with advanced tumor stage (P < 0.01), lower histological differentiation (P = 0.01), and the presence of pleural invasion (P = 0.01). Patients with STAS had significantly shorter recurrence‐free survival (RFS) and overall survival (OS) than those without STAS (P < 0.01 and P = 0.02, respectively). According to multivariate analysis, positivity for STAS was an independent prognostic parameter for RFS (P < 0.01), but not OS (P = 0.45). Three patients who developed surgical margin recurrence and one patient who developed distant recurrence were all positive for STAS.ConclusionsSTAS was predictive of poor postoperative survival in patients with early‐stage adenocarcinomas treated with limited resection and was associated with surgical margin recurrence.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

et al. 2018

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“…STAS is also associated with recurrence and survival in squamous cell carcinoma, lung large cell neuroendocrine carcinoma, and lung small cell carcinoma, even lung pleomorphic carcinoma . STAS has been reported to be related with an aggressive tumor behavior, such as a larger tumor size, a high pathologic stage, lymphatic or vascular invasion, pleural invasion, tumor budding and increased micropapillary or solid structures in lung adenocarcinomas . We previously reported that the positive rate of STAS may be different for different invasive patterns and even lymph node metastasis .…”

Section: Discussionmentioning

confidence: 95%

Relevance and prognostic ability of Twist, Slug and tumor spread through air spaces in lung adenocarcinoma

Liu

Sun

et al. 2020

Cancer Medicine

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Background Tumor spread through air spaces (STAS) is a novel pathologic characteristic in lung adenocarcinomas that indicates invasive tumor behavior. We aimed to explore the relationship between Twist, Slug and STAS in lung adenocarcinoma and to investigate the potential relationship between epithelial‐mesenchymal transition (EMT) and STAS. Materials and methods Our study retrospectively analyzed 115 patients with resected lung adenocarcinomas to evaluate the relationship between Twist, Slug and STAS. STAS was diagnosed using hematoxylin‐eosin (H&E) staining. Immunohistochemistry was used to evaluate the expression levels of Slug and Twist. Results In this study, 56 (48.7%) patients had STAS, 40 (34.8%) patients had Slug overexpression, and 28 (24.3%) patients had Twist overexpression. Patients with either STAS or Slug and Twist overexpression experienced poor recurrence‐free survival (RFS) and overall survival (OS). There were significant associations between Twist overexpression, Slug overexpression and the presence of STAS. The logistic model further revealed that pathological stage, Twist overexpression and Slug overexpression were independent risk factors for STAS. A multivariate analysis that contained Twist, Slug, pathologic stage and STAS, showed that pathologic stage and STAS were independent prognostic factors for poor RFS and OS. Another multivariate model that contained Twist, Slug and pathologic stage, showed that pathologic stage, Twist overexpression and Slug overexpression were independent risk factors for poor RFS and OS. In the cohort with STAS, the multivariate analysis showed that pathologic stage and Twist overexpression were independent risk factors for poor survival. The subgroup analysis showed that patients with both Slug overexpression and Twist overexpression with STAS received a poor prognosis. Conclusions STAS, Slug and Twist were correlated with poor RFS and OS in resected lung adenocarcinomas. Additionally, STAS was correlated with the overexpression of Twist and Slug, which could potentially provide information on the mechanism of STAS.

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CT‐based radiomics model to predict spread through air space in resectable lung cancer

Gong,

Yin,

Sun

et al. 2023

Cancer Medicine

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BackgroundSpread through air space (STAS) has been identified as a pathological pattern associated with lung cancer progression. Patients with STAS were related to a worse prognosis compared with patients without STAS. The objective of this study was to establish a radiomics model capable of forecasting STAS before surgery, which can assist surgeons in selecting the most appropriate operation type for patients with STAS.MethodThere were 537 eligible patients retrospectively included in this study. ROI segmentation was performed manually on all CT images to identify the region of interest. From each segmented lesion, a total of 1688 features were extracted. The tumor size, maximum tumor diameters, and tumor type were also recorded. Using Spearman's correlation coefficient to calculate the correlation and redundancy of elements, and redundant features less than 0.80 were removed. In order to reduce the level of overfitting and avoid statistical biases, a dimension reduction process of the dataset was conducted to decrease the number of features. Finally, a radiomics model included 44 features was established to predict STAS. To evaluate the performance of the model, the receiver operating characteristic (ROC) curve was used, and the area under the curve (AUC) was calculated, and the accuracy of the model was verified by 10‐fold cross‐validation.ResultsThe incidence of STAS was 38.2% (205/537). The tumor type, maximum tumor diameters, and consolidation tumor ratio were significantly different between STAS group and non‐STAS group. The training group included 430 patients, while the test group was consisted with 107. The training group achieved an AUC of 0.825 (sensitivity, 0.875; specificity, 0.621; and accuracy, 0.749) and the test group had an AUC of 0.802 (sensitivity, 0.797; specificity,0.688; and accuracy, 0.748). The 10‐fold cross‐validation had an AUC of 0.834.ConclusionCT‐based radiomic model can predict STAS effectively, which is of great importance to guide the selection of operation types before surgery.

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Spread Through Air Spaces Is a Prognostic Factor in Sublobar Resection of Non-Small Cell Lung Cancer

Abstract: STAS is a prognostic factor of poor outcomes for sublobar resection in patients with lung cancer. The worse prognosis for sublobar resection would be associated with STAS.

Cited by 70 publications

References 22 publications

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

Relevance and prognostic ability of Twist, Slug and tumor spread through air spaces in lung adenocarcinoma

CT‐based radiomics model to predict spread through air space in resectable lung cancer

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