Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Mod Pathol. 2021 Mar;34(3):549-561. doi: 10.1038/s41379-020-00709-2. Epub 2020 Nov 16.
Tumor spread through air spaces (STAS) is an invasive pattern of lung cancer that was recently described. In this study, we investigated the association between the extent of STAS and clinicopathological characteristics and patient outcomes in resected non-small cell lung cancers (NSCLCs). STAS has been prospectively described from 2008 and graded its extent with a two-tiered system (STAS I: <2500 μm [one field of ×10 objective lens] from the edge of tumor and STAS II: ≥2500 μm from the edge of tumor) from 2011 in Seoul National University Bundang Hospital. We retrospectively analyzed the correlations between the extent of STAS and clinicopathologic characteristics and prognostic significance in 1869 resected NSCLCs. STAS was observed in 765 cases (40.9%) with 456 STAS I (24.4%) and 309 STAS II (16.5%). STAS was more frequently found in patients with adenocarcinoma (ADC) (than squamous cell carcinoma), pleural invasion, lymphovascular invasion, and/or higher pathologic stage. In ADC, there were significant differences in recurrence free survival (RFS), overall survival (OS), and lung cancer specific survival (LCSS) according to the extent of STAS. In stage IA non-mucinous ADC, multivariate analysis revealed that STAS II was significantly associated with shorter RFS and LCSS (p < 0.001 and p = 0.006, respectively). In addition, STAS II was an independent poor prognostic factor for recurrence in both limited and radical resection groups (p = 0.001 and p = 0.023, respectively). In conclusion, presence of STAS II was an independent poor prognostic factor in stage IA non-mucinous ADC regardless of the extent of resection.
肿瘤通过气腔播散(STAS)是一种最近被描述的肺癌侵袭模式。在这项研究中,我们研究了在切除的非小细胞肺癌(NSCLC)中,STAS 的程度与临床病理特征和患者结局之间的关系。自 2008 年以来,STAS 已被前瞻性描述,并自 2011 年以来在首尔国立大学盆唐医院采用两级系统(STAS I:肿瘤边缘<2500μm[10 倍物镜视野]和 STAS II:肿瘤边缘≥2500μm)对其程度进行分级。我们回顾性分析了 1869 例切除的 NSCLC 中 STAS 程度与临床病理特征的相关性及其预后意义。765 例(40.9%)观察到 STAS,其中 456 例为 STAS I(24.4%),309 例为 STAS II(16.5%)。STAS 更常见于腺癌(ADC)(而非鳞状细胞癌)、胸膜侵犯、脉管侵犯和/或更高的病理分期的患者。在 ADC 中,根据 STAS 的程度,无复发生存(RFS)、总生存(OS)和肺癌特异性生存(LCSS)存在显著差异。在 IA 期非黏液性 ADC 中,多变量分析显示 STAS II 与较短的 RFS 和 LCSS 显著相关(p<0.001 和 p=0.006)。此外,STAS II 是局限性和根治性切除两组复发的独立不良预后因素(p=0.001 和 p=0.023)。总之,STAS II 的存在是 IA 期非黏液性 ADC 无论切除范围如何的独立不良预后因素。