Journal
JOURNAL OF THORACIC ONCOLOGY
Volume 12, Issue 7, Pages 1052-1060Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jtho.2017.03.020
Keywords
Spread through air spaces; Adenocarcinoma; Invasion; Recurrence; Prognosis
Categories
Funding
- Shanghai Hospital Development Center [SHDC12015116]
- Science and Technology Commission of Shanghai Municipality [15411968400, 14411962600]
- Health and Family Planning Commission of Shanghai Municipality [2013ZYJB0003, 20154Y0097]
- Shanghai Pujiang Program [15PJD034]
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Objectives: Tumor spread through air spaces (STAS) is a novel invasive pattern in lung adenocarcinoma (ADC). The effects of the combination of STAS and tumor size on survival have not been well studied. Methods: A total of 383 patients with ADC 3 cm or smaller (stage IA) and 161 patients with stage IB ADC were identified from 2009 to 2010. Recurrence-free survival (RFS) and overall survival (OS) were compared between patients as stratified by STAS and tumor size. A validation cohort was included in this study. Results: STAS was observed in 116 ADCs 3 cm or smaller (30.3%). In cases involving ADCs 3 cm or smaller, patients with STAS had worse RFS (p = 0.006) and OS rates (p < 0.001) than those without STAS. Furthermore, comparable RFS (p = 0.091) and OS (p = 0.443) rates were observed in patients with ADCs 3 cm or smaller with STAS present and those with stage IB ADC. Multivariate analysis revealed STAS to be an independent prognostic factor in ADCs 3 cm or smaller (RFS, p = 0.043; OS, p = 0.009). Among patients with ADCs larger than 2 to 3 cm, STAS still stratified the prognosis. Moreover, the unfavorable prognosis of patients with ADCs larger than 2 to 3 cm with STAS present was similar to that of patients with stage IB ADC. Among patients with ADCs 2 cm or smaller, STAS failed to stratify the prognosis significantly. Similar results were obtained in the validation cohort. Conclusions: These results provide preliminary evidence that STAS could be considered as a factor in a staging system to predict prognosis more precisely, especially in ADCs larger than 2 to 3 cm. (C) 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
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