2010年1月至2017年12月期间接受肺腺癌切除术的968例T1-3N0M0期患者。其中，787名患者进行了组织学检查。我们检查了STAS，STAS特征（微乳头，实心巢或单细胞），平均密度（每张玻片的数量）和距检测到STAS的肿瘤最远的距离或最大扩散距离（MSD）的存在。
在T1-3N0M0 肺腺癌中，有49.4%（389/787例，）的患者回顾后有STAS，这个数据是至今所见文献中最高的！
STAS+组10年内OS和无复发生存率显着降低（p<0.0001）。局部和远处复发的发生率与STAS组相比，STAS+组在10年内几乎翻了一番（分别为p=0.002和<0.0001）。
在根据STAS特征调整的多因素Cox回归模型中，距离和肿瘤大小，肺叶切除并未赋予STAS患者生存优势（亚肺叶切除相对于肺叶切除的风险比：1.44[95%CI:0.98-2.11]，p=0.067）。在STAS+组中，STAS密度为每张载玻片2.7±1.4个簇，MSD为距肿瘤边缘2.2±1.7mm。STAS密度或MSD与OS或复发之间没有观察到相关性。
目前已知的预后相关高危因素均与STAS有关！
STAS与更高的局部复发和远处复发有关。肺叶切除可能与降低STAS患者局部复发，但并不能降低远处复发。
来自以下医院的研究：
Division of Thoracic and Cardiac Surgery, Department of Surgery, bThoracic Pathology, Department of Pathology, Brigham andWomen’s Hospital, Boston, Mass; and cDepartment of Data Science, Dana-Farber Cancer Institute, Boston, Mass.
Objectives: Spread through air spaces is defined as tumor cells in air spaces away from the edge of tumor in lung carcinoma. It is associated with higher locoregional recurrence and lower survival in lung adenocarcinoma. The features of spread through air spaces portending worse outcomes are still under investigation. We reviewed our lung cancer experience to define potential factors related to spread through air spaces that influence recurrence and survival.
Methods: Between January 2010 and December 2017, we identified 968 patients who underwent resection for T1-3N0M0 lung adenocarcinoma. Of these, histologic examination was possible in 787 patients. We examined the presence of spread through air spaces, spread through air spaces characteristics (micropapillary, solid nest, or single cell), average density (number per slide), and farthest distance from tumor at which spread through air spaces was detected, or maximal spread distance. Overall survival and recurrence-free survival were estimated using Kaplan-Meier curves, and differences between spread through air spaces positive versus spread through air spaces negative groups were assessed using the log-rank test.
Results: Spread through air spaces was present in 389 of 787 of the reviewed cases (49.4%). Overall survival and recurrence-free survival were significantly lower in the spread through air spaces positive group over 10 years (P < .0001). The incidences of locoregional and distant recurrence were nearly doubled over 10 years in the spread through air spaces positive group compared with the spread through air spaces negative group (P = .002 and <.0001, respectively). In a multivariable Cox regression model adjusted for spread through air spaces characteristics, distance, and tumor size, lobar resection did not confer survival advantage in patients with spread through air spaces (hazard ratio of sublobar resection with respect to lobar resection, 1.44; 95% confidence interval, 0.98-2.11; P = .067). In the spread through air spaces positive group, spread through air spaces density was 2.7 ± 1.4 clusters per slide and the maximal spread distance was 2.2 ± 1.7 mm from the tumor edge. There was no observed correlation between spread through air spaces density or maximal spread distance and overall survival or recurrence.
Conclusions: We show increased distant recurrence in spread through air spaces positive lung adenocarcinoma. Quantifiable measures of spread through air spaces do not appear to correlate with recurrence or survival metrics.
参考文献：
Khalil HA, Shi W, Mazzola E, Lee DN, Norton-Hughes E, Dolan D, Corman S, White A, Sholl LM, Swanson SJ. Analysis of recurrence in lung adenocarcinoma with spread through air spaces. J Thorac Cardiovasc Surg. 2023 Nov;166(5):1317-1328.e4. doi: 10.1016/j.jtcvs.2023.01.030. Epub 2023 Feb 16. PMID: 36935300.
