Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Republic of Korea.
Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Republic of Korea.
Lung Cancer. 2020 Apr;142:28-33. doi: 10.1016/j.lungcan.2020.02.001. Epub 2020 Feb 4.
The sensitivity for tumor spread through air space (STAS), an independent risk factor for locoregional recurrence after sublobar resection for lung cancer, has been relatively low in frozen sections. We aimed to determine predictors with high negative predictive value for the presence of STAS and to provide the flowchart in combination with these predictors for the decision-making for sublobar resection.
Between July 2015 and December 2017, 387 patients who underwent surgery for non-small cell lung cancer (NSCLC) with pathologic findings of the total masses measuring ≤ 2 cm were enrolled. The lesions were divided into two groups according to presence of STAS. We compared the preoperative characteristics, operative data, and developed a flowchart for STAS prediction using receiver operator characteristic curve analysis and multivariable logistic regression.
The STAS-positive group (N = 111) had a significantly higher preoperative tumor size (1.70 [1.5] vs 1.50 [0.69], p < 0.001) and standardized uptake value tumor-to-liver (SUV T/L) ratio (1.40 [1.60] vs 0.60 [1.10], p < 0.001) and a significantly lower two-dimensional ground-glass opacity (GGO) percentage (35.86 [61.00] vs 78.14 [39.00], p < 0.001). Meanwhile, the STAS-negative group (N = 286) had higher lepidic predominance (41.6% vs. 1.8%, p < 0.001). We developed a flowchart for predicting STAS in combination with two-dimensional GGO percentage on computed tomography (CT), SUV T/L ratio on positron-emission CT, and lepidic predominant pattern. The sensitivity, specificity, and negative predictive value for STAS positivity were 79.3%, 68.5%, and 89.5%, respectively.
The stepwise flowchart using two-dimensional GGO percentage on CT, maximum SUV, and lepidic predominance might be helpful in selecting patients with early NSCLC for sublobar resection.
肿瘤通过气腔播散（STAS）是肺癌亚肺叶切除后局部区域复发的独立危险因素，其在冷冻切片中的敏感性相对较低。本研究旨在确定具有高阴性预测值的 STAS 存在预测因子，并结合这些预测因子为亚肺叶切除术的决策提供流程图。
2015 年 7 月至 2017 年 12 月，共纳入 387 例因非小细胞肺癌（NSCLC）接受手术且总病变直径≤2cm 的患者。根据是否存在 STAS 将病变分为两组。我们比较了术前特征、手术数据，并通过受试者工作特征曲线分析和多变量逻辑回归制定了 STAS 预测流程图。
STAS 阳性组（N=111）的术前肿瘤大小显著更大（1.70[1.5] vs 1.50[0.69]，p<0.001），标准化摄取值肿瘤/肝脏（SUV T/L）比值显著更高（1.40[1.60] vs 0.60[1.10]，p<0.001），二维磨玻璃密度（GGO）百分比显著更低（35.86[61.00] vs 78.14[39.00]，p<0.001）。同时，STAS 阴性组（N=286）的贴壁生长为主型比例更高（41.6% vs. 1.8%，p<0.001）。我们制定了一个结合 CT 上二维 GGO 百分比、正电子发射 CT 上 SUV T/L 比值和贴壁生长为主型模式预测 STAS 的流程图。STAS 阳性的灵敏度、特异度和阴性预测值分别为 79.3%、68.5%和 89.5%。
使用 CT 上二维 GGO 百分比、最大 SUV 和贴壁生长为主型的逐步流程图可能有助于选择早期 NSCLC 患者行亚肺叶切除术。
