OBJECTIVE Spread through air spaces (STAS) is a pattern of invasion present in some adenocarcinomas (ADC). The goal of this study was to assess the impact of STAS in patients treated with different types of surgical resections and on the clinical outcome in patients with ADC of different diameters and with different degrees of nodal involvement. METHODS A total of 109 patients were reviewed. Complete surgical resection with systematic nodal dissection was achieved in all patients. The median follow-up was 65 months (3–90 months). RESULTS STAS was observed in 70 cases (64.2%); 13 patients (18.5%) had lymph node involvement (N1 and N2). Overall survival and progression-free survival were higher in patients without STAS (P = 0.042; P = 0.027). The presence of STAS in tumours ≤2 cm was a predictor of worse progression-free survival following sublobar resection compared to major resections (P = 0.011). Sublobar resection of N0 STAS-positive tumours was associated with worse long-term survival compared to a major resection (P = 0.04). Statistical analyses showed that age >70 years and recurrence were independent variables for survival; smoking pack-years >20, sublobar resection and nodal involvement were independent variables for recurrence; and smoking pack-years >20 were independent variables for a history of cancer and pleural invasion for local recurrence. CONCLUSIONS STAS seems to play a role in long-term survival, particularly for patients with N0 and tumours smaller than 2 cm. Further studies are necessary to validate this hypothesis.

中文翻译：

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通过气腔传播对肺腺癌的预后影响


目的 通过空气空间传播 (STAS) 是某些腺癌 (ADC) 中存在的一种侵袭模式。本研究的目的是评估 STAS 对接受不同类型手术切除的患者的影响，以及对不同直径和不同淋巴结受累程度的 ADC 患者临床结果的影响。方法 总共对 109 名患者进行了回顾。所有患者均实现了完整的手术切除和系统性淋巴结清扫。中位随访时间为 65 个月（3-90 个月）。结果 70例（64.2%）出现STAS； 13 名患者（18.5%）有淋巴结受累（N1 和 N2）。无 STAS 患者的总生存期和无进展生存期较高（P = 0.042；P = 0.027）。与大切除术相比，≤2 cm 肿瘤中存在 STAS 是亚肺叶切除术后无进展生存率较差的预测因子 (P = 0.011)。与大切除术相比，N0 STAS 阳性肿瘤的亚肺叶切除术与更差的长期生存相关（P = 0.04）。统计分析表明，年龄>70岁和复发是生存的自变量；吸烟年数>20、亚肺叶切除和淋巴结受累是复发的独立变量；吸烟包年数 >20 是癌症病史和局部复发胸膜侵犯的自变量。结论 STAS 似乎在长期生存中发挥作用，特别是对于 N0 和肿瘤小于 2 cm 的患者。需要进一步的研究来验证这一假设。