In recent years, the concept of spread through air spaces (STAS) has been discussed as an adverse prognostic factor for lung cancer. The aim of our study is to clarify the prognostic role of STAS in relation to the main recognized prognostic factors in a retrospective cohort of 330 European patients who underwent stages I to III lung adenocarcinoma resection. On univariate analysis, the presence of STAS was related to progression-free survival (PFS; hazard ratio [HR]: 1.48; 95% CI: 1.02-2.19; P = 0.038) and overall survival (OS; HR: 1.61; 95% CI: 1.03-2.52; P = 0.50). On multivariate analysis, STAS was related to PFS (HR: 1.51; 95% CI: 1.00-2.17; P = 0.050) and to OS (HR: 1.67; 95% CI: 1.00-2.81; P = 0.050). We showed that the presence of STAS was associated with lower PFS, equivalent to the next pathologic T stage, especially the median PFS of T3 stages without STAS was at 62.8 months while the median PFS of T3 stages with STAS was at 15.7 months, closer to the median PFS of 17.4 months in T4 stages. To conclude, STAS is an independent prognostic factor of PFS in this European cohort and is close to significance for OS. We suggest that the presence of STAS might lead to an upstaging of lung adenocarcinoma.

中文翻译：

---

I 期至 III 期切除肺腺癌通过空气空间传播：通过空气空间传播的存在是否会导致分期升级？

近年来，空气空间传播（STAS）的概念被认为是肺癌的不良预后因素。我们的研究目的是在由 330 名接受 I 至 III 期肺腺癌切除术的欧洲患者组成的回顾性队列中，阐明 STAS 与主要公认预后因素相关的预后作用。在单变量分析中，STAS 的存在与无进展生存期（PFS；风险比 [HR]：1.48；95% CI：1.02-2.19；P = 0.038）和总生存期（OS；HR：1.61；95%）相关。 CI：1.03-2.52；P = 0.50）。多变量分析显示，STAS 与 PFS（HR：1.51；95% CI：1.00-2.17；P = 0.050）和 OS（HR：1.67；95% CI：1.00-2.81；P = 0.050）相关。我们发现，STAS 的存在与较低的 PFS 相关，相当于下一个病理 T 分期，特别是没有 STAS 的 T3 期的中位 PFS 为 62.8 个月，而有 STAS 的 T3 期的中位 PFS 为 15.7 个月，更接近于T4 阶段的中位 PFS 为 17.4 个月。总之，STAS 是该欧洲队列中 PFS 的独立预后因素，并且与 OS 的意义接近。我们认为 STAS 的存在可能会导致肺腺癌的分期升级。