Department of Thoracic Surgery, Hebei Provincal General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.
Pathol Oncol Res. 2019 Oct;25(4):1303-1310. doi: 10.1007/s12253-019-00616-1. Epub 2019 Feb 14.
Surgical resection is the most effective treatment for early stage lung adenocarcinoma. However, the rate of 5-year postoperative recurrence reaches 30%, Spread Through Air Spaces(STAS) is a recently described novel invasive pattern of lung cancer, According to the 2015 WHO classification. STAS is defined as"micropapillary clusters, solid nests, or single cells spreading within air spaces beyond the edge of the main tumor, However, the prognostic role of STAS in lung cancer is not known, The aim of the current study is to evaluate the association between STAS and clinical outcome of lung cancer patients after surgical resection through a meta-analysis. Systematic research was conducted using three online databases to search for studies published before August 1, 2018. The 5-year RFS and OS for non-small cell lung cancer patients after surgical resection with or without STAS were compared. The studies were selected according to rigorous inclusion and exclusion criteria. Meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effective measures. Included in our meta-analysis were 12 studies, published from 2015 to 2018, with a total of 3564 patients. Our results clearly depicted that the presence of STAS predicted a worse outcome for 5-year RFS with the combined HR of 1.84(95% CI: 1.59-2.12). Meta-analysis of these 8 studies showed that patients with the presence of STAS were associated with shorter 5-year OS (the pooled HR:1.78, 95% CI: 1.51-2.11). This meta-analysis illuminated that the presence of STAS might be a unfavorable prognostic factor for patients with NSCLC. it should be paid sufficient attention and recorded in pathologic reports, which can indicate treatment choice and prognosis of patients. In future, more studies with well-designed and large-scale are needed to confirm the conclusion.
手术切除是治疗早期肺腺癌最有效的方法。然而，术后 5 年复发率高达 30%。散布在气腔中的肿瘤细胞（STAS）是最近描述的一种新型肺癌侵袭模式，根据 2015 年世界卫生组织（WHO）分类。STAS 被定义为“微乳头簇、实性巢或单个细胞在肿瘤边缘以外的气腔内扩散”。然而，STAS 在肺癌中的预后作用尚不清楚。本研究旨在通过荟萃分析评估 STAS 与肺腺癌患者术后临床结局的关系。系统检索了三个在线数据库，以搜索截至 2018 年 8 月 1 日之前发表的研究。比较了有或无 STAS 的肺腺癌患者手术后 5 年无复发生存率（RFS）和总生存率（OS）。根据严格的纳入和排除标准选择研究。使用风险比（HR）和 95%置信区间（CI）作为有效测量值进行荟萃分析。本荟萃分析纳入了 12 项研究，发表时间为 2015 年至 2018 年，共 3564 例患者。我们的研究结果清楚地表明，STAS 的存在预测 5 年 RFS 结局较差，合并 HR 为 1.84（95%CI：1.59-2.12）。对这 8 项研究的荟萃分析显示，存在 STAS 的患者与较短的 5 年 OS 相关（合并 HR：1.78，95%CI：1.51-2.11）。本荟萃分析表明，STAS 的存在可能是 NSCLC 患者的不利预后因素。应该在病理报告中充分重视并记录下来，以便为患者的治疗选择和预后提供依据。未来需要更多设计良好、规模较大的研究来证实这一结论。
