Lu Shaohua, Tan Kay See, Kadota Kyuichi, Eguchi Takashi, Bains Sarina, Rekhtman Natasha, Adusumilli Prasad S, Travis William D
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
J Thorac Oncol. 2017 Feb;12(2):223-234. doi: 10.1016/j.jtho.2016.09.129. Epub 2016 Sep 28.
Spread through air spaces (STAS) is a recently recognized pattern of invasion in lung adenocarcinoma; however, it has not yet been characterized in squamous cell carcinoma (SCC).
We reviewed 445 resected stage I to III lung SCCs and investigated the clinical significance of STAS. Cumulative incidence of recurrence and lung cancer-specific death were evaluated by competing risks analyses and overall survival by Cox models.
Of the total 445 patients, 336 (76%) were older than 65 years. Among the 273 patients who died, 91 (33%) died of lung cancer whereas the remaining ones died of competing events or unknown cause. STAS was observed in 132 patients (30%) and the frequency increased with stage. The cumulative incidences of any, distant, and locoregional recurrence as well as lung cancer-specific death were significantly higher in patients with STAS compared with in those without STAS, whereas there was no statistically significant difference in overall survival. In multivariable models for any recurrence and lung cancer-specific death, STAS was an independent predictor for both outcomes (p = 0.034 and 0.016, respectively).
STAS was present in one-third of resected lung SCCs. In competing risks analysis in a cohort in which three-fourths of the patients were elderly, STAS was associated with lung cancer-specific outcomes. Our findings suggest that STAS is one of the most prognostically significant histologic findings in lung SCC.
气腔播散（STAS）是肺腺癌中一种最近才被认识的侵袭模式；然而，它在肺鳞状细胞癌（SCC）中尚未得到描述。
我们回顾了445例I至III期肺SCC切除病例，并研究了STAS的临床意义。通过竞争风险分析评估复发的累积发生率和肺癌特异性死亡情况，并通过Cox模型评估总生存期。
在总共445例患者中，336例（76%）年龄超过65岁。在273例死亡患者中，91例（33%）死于肺癌，其余患者死于竞争事件或死因不明。132例患者（30%）观察到STAS，其频率随分期增加。与无STAS的患者相比，有STAS的患者任何、远处和局部区域复发以及肺癌特异性死亡的累积发生率显著更高，而总生存期无统计学显著差异。在任何复发和肺癌特异性死亡的多变量模型中，STAS是这两种结局的独立预测因素（分别为p = 0.034和0.016）。
STAS存在于三分之一的肺SCC切除病例中。在四分之三患者为老年人的队列的竞争风险分析中，STAS与肺癌特异性结局相关。我们的研究结果表明，STAS是肺SCC中最具预后意义的组织学发现之一。
