Kadota Kyuichi, Kushida Yoshio, Katsuki Naomi, Ishikawa Ryou, Ibuki Emi, Motoyama Mutsumi, Nii Kazuhito, Yokomise Hiroyasu, Bandoh Shuji, Haba Reiji
Departments of *Diagnostic Pathology †General Thoracic Surgery ‡Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Am J Surg Pathol. 2017 Aug;41(8):1077-1086. doi: 10.1097/PAS.0000000000000872.
Tumor spread through air spaces (STAS) is a newly recognized pattern of invasion in lung adenocarcinoma. However, clinical significance of STAS has not yet been characterized in lung squamous cell carcinoma. In this study, we investigated whether STAS could determine clinical outcome in Japanese patients with lung squamous cell carcinoma. We reviewed tumor slides from surgically resected lung squamous cell carcinomas (n=216). STAS was defined as tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor. Tumors were evaluated for histologic subtypes, tumor budding, and nuclear diameter. Recurrence-free survival (RFS) was analyzed using the log-rank test and the Cox proportional hazards model. Tumor STAS was observed in 87 patients (40%), increasing incidence with lymph node metastasis (P=0.037), higher pathologic stage (P=0.026), and lymphatic invasion (P=0.033). All cases with STAS showed a solid nest pattern. The 5-year RFS for patients with STAS was significantly lower than it was for patients without STAS in all patients (P=0.001) and in stage I patients (n=134; P=0.041). On multivariate analysis, STAS was an independent prognostic factor of a worse RFS (hazard ratio=1.61; P=0.023). Patients with STAS had a significantly increased risk of developing locoregional and distant recurrences (P=0.012 and 0.001, respectively). We found that tumor STAS was an independent predictor of RFS in patients with resected lung squamous cell carcinoma, and it was associated with aggressive tumor behavior.
肿瘤气腔播散（STAS）是肺腺癌一种新认识的侵袭模式。然而，STAS在肺鳞状细胞癌中的临床意义尚未明确。在本研究中，我们调查了STAS是否能决定日本肺鳞状细胞癌患者的临床结局。我们回顾了手术切除的肺鳞状细胞癌（n = 216）的肿瘤切片。STAS定义为肺实质气腔内超出主肿瘤边缘的肿瘤细胞。对肿瘤进行组织学亚型、肿瘤芽生和核直径评估。采用对数秩检验和Cox比例风险模型分析无复发生存期（RFS）。87例患者（40%）观察到肿瘤STAS，其发生率随淋巴结转移（P = 0.037）、更高病理分期（P = 0.026）和淋巴管侵犯（P = 0.033）而增加。所有有STAS的病例均表现为实性巢状模式。在所有患者中（P = 0.001）以及I期患者（n = 134；P = 0.041）中，有STAS患者的5年RFS显著低于无STAS患者。多因素分析显示，STAS是RFS较差的独立预后因素（风险比 = 1.61；P = 0.023）。有STAS的患者发生局部区域和远处复发的风险显著增加（分别为P = 0.012和0.001）。我们发现肿瘤STAS是肺鳞状细胞癌切除患者RFS的独立预测因素，且与侵袭性肿瘤行为相关。
