Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
J Cancer Res Clin Oncol. 2019 Sep;145(9):2375-2382. doi: 10.1007/s00432-019-02972-6. Epub 2019 Jul 10.
Spread through air spaces (STAS) as a pattern of invasion in lung adenocarcinomas had been recognized by WHO in 2015. Moreover, STAS was associated significantly with aggressive micropapillary or solid components when presented predominant pattern in lung adenocarcinomas, which had a poor prognostic significance. Small amounts of micropapillary or solid with components could also reduce overall survival and recurrence-free survival but its impact on STAS is unknown now. Some studies have demonstrated manipulations of surgeons and pathologists could affect STAS but the degree of these impacts is not clear.
We reviewed resected small (≤ 2 cm) stage I invasive lung adenocarcinomas by thoracoscopic surgery at our institution from January 2017 to October 2018 (n = 277). Micropapillary or solid pattern was considered to be present when the subtype occupied at least 1% of the entire tumor. Lobectomy and segmentectomy were performed using three portals thoracoscopic surgery. Statistical analysis was performed to analyze the correlations of STAS and clinicopathological characteristics. Moreover, we also analyzed the correlated factors of STAS in solid nodules.
STAS was found in 59 of 163 (36.2%) lobectomy cases and 27 of 114 (23.7%) limited resection cases. Lobectomy group showed a higher incidence of STAS compared with limited resection group (p = 0.027), but the difference was disappeared in multivariate analysis, which showed that STAS was significantly correlated to solid nodules and presence of high grade histologic subtype (mircopapillary or solid). However, both lobectomy and presence of high grade histologic subtype were significantly correlated with STAS in solid nodules.
The small amounts of high grade histologic subtypes were also associated with STAS. Thoracoscopic surgery could affect STAS to some degree.
2015 年，世界卫生组织（WHO）认识到，在肺腺癌中，通过气腔播散（STAS）的模式进行侵袭。此外，当肺腺癌以主要模式表现出明显的微乳头或实性成分时，STAS 与侵袭性微乳头或实性成分显著相关，这具有不良的预后意义。少量的微乳头或实性成分也会降低总生存率和无复发生存率，但目前尚不清楚其对 STAS 的影响。一些研究表明，外科医生和病理学家的操作可能会影响 STAS，但这些影响的程度尚不清楚。
我们回顾了 2017 年 1 月至 2018 年 10 月在我院接受胸腔镜手术切除的小（≤2cm）期 I 浸润性肺腺癌病例（n=277）。当亚型占整个肿瘤的至少 1%时，认为存在微乳头或实性模式。肺叶切除术和肺段切除术采用三孔胸腔镜手术进行。对 STAS 与临床病理特征的相关性进行统计学分析。此外，我们还分析了实性结节中 STAS 的相关因素。
在 163 例肺叶切除病例中，有 59 例（36.2%）和 114 例肺段切除病例中有 27 例（23.7%）发现 STAS。与肺段切除术组相比，肺叶切除术组 STAS 的发生率更高（p=0.027），但多变量分析显示，STAS 与实性结节和高级别组织学亚型（微乳头或实性）显著相关，差异消失。然而，在实性结节中，肺叶切除术和高级别组织学亚型均与 STAS 显著相关。
少量高级别组织学亚型也与 STAS 相关。胸腔镜手术在一定程度上可能会影响 STAS。
