Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Department of Pathology, Peking University People's Hospital, Beijing, China.
Eur J Cardiothorac Surg. 2022 May 27;61(6):1242-1248. doi: 10.1093/ejcts/ezab530.
Spread through air spaces (STAS) is a unique pattern of invasion in primary lung cancers. However, little is known about STAS in pulmonary metastases (PMs). This study was to investigate the incidence of STAS among PMs and the association between STAS and clinicopathological characteristics of PMs.
A total of 127 patients who underwent metastasectomy at our institution from June 2009 to December 2019 were retrospectively analysed. Survival analysis was performed in 40 patients with PM from colorectal cancer (CRC).
STAS was identified in 33.1% of patients (42 of 127) with PMs. STAS was found in PMs of various primary cancers, including CRC, breast cancer, renal cell carcinoma, cholangiocarcinoma and osteogenic and soft tissue sarcoma, but the incidence varies. PMs originating from epithelial tissue showed higher incidence of STAS than those from mesenchymal tissue (45% vs 11%, P < 0.001). Elder age (P = 0.006) and primary sites (P < 0.001) were significantly correlated with STAS. In patients with PMs from CRC, the presence of STAS was an independent predictor of shorter recurrence-free survival (hazard ratio = 10.25, P = 0.002) and poor overall survival (hazard ratio = 4.75, P = 0.047) by multivariable analysis.
STAS might be a lung-specific tumour invasion pattern and STAS is commonly observed in PMs of different origins. The incidence of STAS was significantly higher in PMs originating from epithelial tissues than those from mesenchymal tissues. Presence of STAS was an independent predictor of poor prognosis in patients with PM from CRC.
气腔内播散（STAS）是原发性肺癌侵袭的一种独特模式。然而，关于肺转移瘤（PMs）中的 STAS 知之甚少。本研究旨在探讨 PMs 中 STAS 的发生率以及 STAS 与 PMs 临床病理特征之间的关系。
回顾性分析了 2009 年 6 月至 2019 年 12 月在我院行转移瘤切除术的 127 例患者。对 40 例结直肠癌（CRC）来源的 PM 患者进行生存分析。
在 127 例 PM 患者中（42/127）发现了 STAS，发生率为 33.1%。STAS 见于包括 CRC、乳腺癌、肾细胞癌、胆管癌和骨源性及软组织肉瘤在内的各种原发性癌症的 PM 中，但发生率不同。来源于上皮组织的 PM 比来源于间叶组织的 PM 具有更高的 STAS 发生率（45%比 11%，P<0.001）。年龄较大（P=0.006）和原发部位（P<0.001）与 STAS 显著相关。在 CRC 来源的 PM 患者中，多变量分析显示 STAS 的存在是无复发生存（风险比=10.25，P=0.002）和总生存（风险比=4.75，P=0.047）较差的独立预测因素。
STAS 可能是一种肺特异性肿瘤侵袭模式，STAS 常见于不同来源的 PM 中。来源于上皮组织的 PM 中 STAS 的发生率明显高于来源于间叶组织的 PM。STAS 的存在是 CRC 来源的 PM 患者预后不良的独立预测因素。
