Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score–matched analysis Journal Article


Authors: Eguchi, T.; Kameda, K.; Lu, S.; Bott, M. J.; Tan, K. S.; Montecalvo, J.; Chang, J. C.; Rekhtman, N.; Jones, D. R.; Travis, W. D.; Adusumilli, P. S.
Article Title: Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score–matched analysis
Abstract: Introduction: Spread through air spaces (STAS) is a form of invasion wherein tumor cells extend beyond the tumor edge within the lung parenchyma. In lung adenocarcinoma (ADC), we investigated the (1) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (2) effect of surgical margin-to-tumor diameter ratio in STAS-positive patients, and (3) potential utility of frozen sections (FSs) for detecting STAS intraoperatively. Methods: We investigated 1497 patients who underwent lobectomy (n = 970) or sublobar resection (n = 527) for T1N0M0 lung ADC after propensity score matching. Outcomes were analyzed by using a competing risks approach. The effect of margin-to-tumor ratio on recurrence pattern (locoregional and distant) was investigated in patients who underwent sublobar resection. Five pathologists evaluated the feasibility of intraoperatively identifying STAS by using FSs (sensitivity, specificity, and interrater reliability). Results: On multivariable analysis after propensity score matching (349 pairs/procedure), sublobar resection was significantly associated with recurrence (subhazard ratio = 2.84 [p < 0.001]) and lung cancer–specific death (subhazard ratio = 2.63 [p = 0.021]) in patients with STAS but not in those without STAS. Patients with STAS who underwent sublobar resection had a higher risk of locoregional recurrence regardless of margin-to-tumor ratio (for a margin-to-tumor ratio of ≥1 versus <1, the 5-year cumulative incidence of recurrence rates were 16% and 25%, respectively); among patients without STAS, locoregional recurrences occurred in patients with margin-to-tumor ratio lower than 1 (a 5-year cumulative incidence of recurrence rate of 7%). The sensitivity and specificity for detecting STAS by use of FSs were 71% and 92%, with substantial interrater reliability (Gwet's AC1, 0.67). Conclusions: In patients with T1 lung ADC with STAS, lobectomy was associated with better outcomes than sublobar resection was. Pathologists can recognize STAS on FSs. © 2018 International Association for the Study of Lung Cancer
Keywords: adult; controlled study; treatment outcome; aged; major clinical study; cancer recurrence; postoperative period; cancer risk; cancer staging; cancer incidence; prospective study; sensitivity and specificity; lung lobectomy; lung resection; cohort analysis; recurrence; retrospective study; cancer mortality; lung adenocarcinoma; feasibility study; intraoperative period; lobectomy; interrater reliability; wedge resection; sublobar resection; propensity score; human; male; female; priority journal; article
Journal Title: Journal of Thoracic Oncology
Volume: 14
Issue: 1
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2019-01-01
Start Page: 87
End Page: 98
Language: English
DOI: 10.1016/j.jtho.2018.09.005
PROVIDER: scopus
PMCID: PMC6309668
PUBMED: 30244070
DOI/URL:
Notes: J. Thorac. Oncol. -- Cited By :1 -- Export Date: 2 January 2019 -- Article -- Source: Scopus C2 - 30244070
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Citation Impact
MSK Authors
  1. Natasha Rekhtman
    357 Rekhtman
  2. William D Travis
    675 Travis
  3. Matthew Bott
    82 Bott
  4. David Randolph Jones
    290 Jones
  5. Jason Chih-Peng Chang
    81 Chang
  6. Takashi   Eguchi
    71 Eguchi
  7. Kay See   Tan
    166 Tan
  8. Shaohua   Lu
    23 Lu
  9. Koji Kameda
    9 Kameda