Abstract：
BACKGROUND: Spread through air spaces (STAS) consists of lung cancer tumor cells that are identified beyond the edge of the main tumor in the surrounding alveolar parenchyma. It has been reported by meta-analyses to be an independent prognostic factor in the major histologic types of lung cancer, but its role in lung cancer staging is not established.
METHODS: To assess the clinical importance of STAS in lung cancer staging, we evaluated 4061 surgically resected pathologic stage I R0 NSCLC collected from around the world in the International Association for the Study of Lung Cancer database. We focused on whether STAS could be a useful additional histologic descriptor to supplement the existing ones of visceral pleural invasion (VPI) and lymphovascular invasion (LVI).
RESULTS: STAS was found in 930 of 4061 of the pathologic stage I NSCLC (22.9%). Patients with tumors exhibiting STAS had a significantly worse recurrence-free and overall survival in both univariate and multivariable analyses involving cohorts consisting of all NSCLC, specific histologic types (adenocarcinoma and other NSCLC), and extent of resection (lobar and sublobar). Interestingly, STAS was independent of VPI in all of these analyses.
CONCLUSIONS: These data support our recommendation to include STAS as a histologic descriptor for the Ninth Edition of the TNM Classification of Lung Cancer. Hopefully, gathering these data in the coming years will facilitate a thorough analysis to better understand the relative impact of STAS, LVI, and VPI on lung cancer staging for the Tenth Edition TNM Stage Classification.
METHODS: To assess the clinical importance of STAS in lung cancer staging, we evaluated 4061 surgically resected pathologic stage I R0 NSCLC collected from around the world in the International Association for the Study of Lung Cancer database. We focused on whether STAS could be a useful additional histologic descriptor to supplement the existing ones of visceral pleural invasion (VPI) and lymphovascular invasion (LVI).
RESULTS: STAS was found in 930 of 4061 of the pathologic stage I NSCLC (22.9%). Patients with tumors exhibiting STAS had a significantly worse recurrence-free and overall survival in both univariate and multivariable analyses involving cohorts consisting of all NSCLC, specific histologic types (adenocarcinoma and other NSCLC), and extent of resection (lobar and sublobar). Interestingly, STAS was independent of VPI in all of these analyses.
CONCLUSIONS: These data support our recommendation to include STAS as a histologic descriptor for the Ninth Edition of the TNM Classification of Lung Cancer. Hopefully, gathering these data in the coming years will facilitate a thorough analysis to better understand the relative impact of STAS, LVI, and VPI on lung cancer staging for the Tenth Edition TNM Stage Classification.
摘要：
背景：通过空气间隙（STAS）扩散由肺癌肿瘤细胞组成，这些肿瘤细胞在周围肺泡实质的主要肿瘤边缘之外被识别。据荟萃分析报道，它是肺癌主要组织学类型的独立预后因素。但其在肺癌分期中的作用尚未确定。
方法：为了评估STAS在肺癌分期中的临床重要性，我们评估了国际肺癌研究协会数据库中从世界各地收集的4061例手术切除的IR0期NSCLC.我们专注于STAS是否可以作为有用的附加组织学描述符，以补充现有的内脏胸膜浸润（VPI）和淋巴管浸润（LVI）。
结果：STAS在病理I期非小细胞肺癌的4061例中有930例（22.9%）。在涉及所有NSCLC的队列的单变量和多变量分析中，表现为STAS的肿瘤患者的无复发和总生存期明显更差。特定的组织学类型（腺癌和其他NSCLC），和切除范围（叶和亚叶下）。有趣的是,在所有这些分析中,STAS独立于VPI。
结论：这些数据支持我们建议将STAS作为肺癌TNM分类第九版的组织学描述。希望,在未来几年收集这些数据将有助于进行彻底的分析，以更好地了解STAS的相对影响，LVI,和VPI关于肺癌分期的第十版TNM分期分类。
方法：为了评估STAS在肺癌分期中的临床重要性，我们评估了国际肺癌研究协会数据库中从世界各地收集的4061例手术切除的IR0期NSCLC.我们专注于STAS是否可以作为有用的附加组织学描述符，以补充现有的内脏胸膜浸润（VPI）和淋巴管浸润（LVI）。
结果：STAS在病理I期非小细胞肺癌的4061例中有930例（22.9%）。在涉及所有NSCLC的队列的单变量和多变量分析中，表现为STAS的肿瘤患者的无复发和总生存期明显更差。特定的组织学类型（腺癌和其他NSCLC），和切除范围（叶和亚叶下）。有趣的是,在所有这些分析中,STAS独立于VPI。
结论：这些数据支持我们建议将STAS作为肺癌TNM分类第九版的组织学描述。希望,在未来几年收集这些数据将有助于进行彻底的分析，以更好地了解STAS的相对影响，LVI,和VPI关于肺癌分期的第十版TNM分期分类。
