Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma

• Published in: Interactive cardiovascular and thoracic surgery Vol. 23; no. 4; pp. 567 - 572
• Main Authors: Shiono, Satoshi, Yanagawa, Naoki
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.10.2016
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Tomography, X-Ray Computed; Lung pathology; Lung cancer; Lung cancer surgery
• ISSN: 1569-9293; 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivw211

OBJECTIVES Spread through air spaces (STAS) is considered a prognosticator related to local recurrence. We assessed the prognostic impact of spread through air spaces and local recurrence in stage I lung adenocarcinoma. METHODS From July 2004 to November 2014, 877 lung cancer patients underwent surgery, of whom 318 with pathological stage I adenocarcinoma were reviewed. We investigated the characteristics of spread through air spaces and analysed the relationship between spread through air spaces and prognosis. RESULTS The median follow-up was 30 months. Of the 318 patients, 47 (14.8%) had spread through air spaces. The patients with spread through air spaces were associated with male sex (P < 0.001), smoking (P < 0.001), solid nodules (P < 0.001), stage IB disease (P = 0.006), epidermal growth factor receptor mutation negativity (P < 0.001), and lymphovascular (P < 0.001) and pleural invasion (P = 0.001). Among the preoperative findings, spread through air spaces was significantly related to solid nodules on computed tomography. Local recurrence occurred in 11 of 47 (23.4%) cases with spread through air spaces and 10 of 271 (3.7%) cases without spread through air spaces (P < 0.01). Univariate analysis showed that the overall 5-year survival rates were 62.7 and 91.1% in cases with and without spread through air spaces, respectively (P < 0.01), and the recurrence-free 5-year survival rates were 54.4 and 87.8% in cases with and without spread through air spaces, respectively (P < 0.01). Multivariate analysis confirmed spread through air spaces as a significant prognosticator for overall survival and a predictive factor for recurrence after surgery. CONCLUSIONS Among stage I lung adenocarcinoma patients, spread through air spaces was found frequently in the invasive cases and was closely related to poor prognosis and recurrence.