Risk factors and prognosis of spread through air space in pT1a-c stage lung adenocarcinoma
Objective To investigate the clinicopathological risk factors and prognosis of spread through air space(STAS)in early lung adenocarcinoma.Methods Retrospective collection of data from 554 patients with lung adenocarcinoma with a tumor diameter ≤3 cm(pT1a-c)who underwent pulmonary resection at the Department of Thoracic Surgery,First Hospi-tal of Hebei Medical University from January 2015 to December 21,2017.Among them,there were 261 males and 293 females,aged 31-79 years,with a median age of 61 years.Mann Whitney U test,x2-test,Fisher exact probability meth-od,and binary logistic regression analysis were used to analyze the prognosis and associated factors affecting the occurrence of STAS.Results Totally 307 patients with stage Ⅰ A(pT1a-cN0M0)lung adenocarcinoma,including 137 males(44.6％)and 170 females(55.4％),developed STAS in 71 cases,with a positive rate of 23.1％.In stage Ⅰ A lung ade-nocarcinoma patients,the ratio of STAS to tumor solid components(CTR,Z=-2.245,P=0.025),vascular tumor thrombus(x2=46.512,P＜0.001),different pathological types(x2=6.782,P=0.011),presence of micropapillary components(Z=-4.569,P＜0.001),and absence of adherent components in pathological subtypes(x2=4.237,P=0.040)were associated.Among all enrolled patients with T≤3 cm(pT1a-c),univariate analysis showed that STAS was associated with vascular thrombosis,pleural invasion,lymph node metastasis,and N-stage(all P＜0.05).The results of multivariate analysis showed that vascular tumor thrombus(OR=0.513,95％CI:0.301-0.874,P=0.014)and pleural infiltration(OR=20.475,95％CI:9.727-43.099,P＜0.001)were independent risk factors for the occurrence of STAS.The survival analysis results showed that STAS positive patients had poorer recurrence free survival and overall survival,both P＜0.05.Conclusion STAS is a poor prognostic factor for early lung adenocarcinoma and is associated with more invasive clinical and pathological features such as CTR,pleural infiltration,vascular tumor thrombus,micro-papillary components,and lymph node metastasis.
lung adenocarcinomaspread through air spaceprognosisvascular tumor thrombus
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