Shi Jinghan, Xu Kuan, Liu Xufeng, Barr Martin P, Velotta Jeffrey B, La-Beck Ninh M, Zhong Chenxi, Yao Feng
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2025 Apr 30;14(4):1384-1394. doi: 10.21037/tlcr-2025-253. Epub 2025 Apr 27.
Tumor spread through air spaces (STAS) and a new histological grading system proposed by the International Association for the Study of Lung Cancer (IASLC) have been studied for risk stratification and prognostic assessment in patients with lung adenocarcinoma (LUAD). This study aimed to clarify the association between STAS and IASLC grade and to assess the prognostic significance of STAS in patients with pathological stage (p-stage) IA LUAD as stratified by the IASLC grading system.
This study included 789 patients with resected p-stage IA LUAD treated between 2018 and 2020. Logistic regression analysis was performed to assess the association between STAS and clinicopathological characteristics. A Cox proportion hazards model was used to assess the risk factors related to recurrence-free survival (RFS) and overall survival (OS).
STAS was present in 242 patients (30.7%). The independent factors associated with the presence of STAS were nodule type [odds ratio (OR) =3.89; 95% confidence interval (CI): 2.69-5.62; P<0.001], IASLC grade (grade 2: OR =12.41, 95% CI: 3.83-40.23; P<0.001; grade 3: OR =27.35, 95% CI: 8.24-90.82, P<0.001), and lymphovascular invasion (OR =3.30; 95% CI: 1.72-6.35; P<0.001). For all patients (N=789), STAS and IASLC grade were independent prognostic factors for RFS and OS. For grade 2 LUAD, p-stage T1c was an independent prognostic factor for RFS [hazard ratio (HR) =4.30, 95% CI: 1.07-19.08; P=0.045] and OS (HR =4.95, 95% CI: 1.14-21.54; P=0.03). STAS was significantly correlated with unfavorable RFS (HR =2.81; 95% CI: 1.32-5.97; P=0.007) and OS (HR =2.04, 95% CI: 1.40-7.75; P=0.006) in patients with grade 3 tumors.
The presence of STAS was not only directly correlated with the IASLC grading system, but was also a prognostic factor for worse RFS and OS in grade 3 LUAD patients.
肿瘤气腔播散（STAS）以及国际肺癌研究协会（IASLC）提出的新组织学分级系统已被用于肺腺癌（LUAD）患者的风险分层和预后评估。本研究旨在阐明STAS与IASLC分级之间的关联，并评估在IASLC分级系统分层的病理分期（p分期）为IA期的LUAD患者中STAS的预后意义。
本研究纳入了2018年至2020年间接受手术切除的789例p分期为IA期的LUAD患者。进行逻辑回归分析以评估STAS与临床病理特征之间的关联。采用Cox比例风险模型评估与无复发生存期（RFS）和总生存期（OS）相关的危险因素。
242例患者（30.7%）存在STAS。与STAS存在相关的独立因素为结节类型[比值比（OR）=3.89；95%置信区间（CI）：2.69 - 5.62；P<0.001]、IASLC分级（2级：OR =12.41，95% CI：3.83 - 40.23；P<0.001；3级：OR =27.35，95% CI：8.24 - 90.82，P<0.001）以及脉管侵犯（OR =3.30；95% CI：1.72 - 6.35；P<0.001）。对于所有患者（N =789），STAS和IASLC分级是RFS和OS的独立预后因素。对于2级LUAD，p分期T1c是RFS[风险比（HR）=4.30，95% CI：1.07 - 19.0八；P =0.045]和OS（HR =4.95，95% CI：1.14 - 21.54；P =0.03）的独立预后因素。在3级肿瘤患者中，STAS与不良RFS（HR =2.81；95% CI：1.32 - 5.97；P =0.007）和OS（HR =2.04，95% CI：1.40 - 7.75；P =0.006）显著相关。
STAS的存在不仅与IASLC分级系统直接相关，也是3级LUAD患者RFS和OS较差的预后因素。
