Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small Stage I lung adenocarcinomas Journal Article

   

Authors:	Kadota, K.; Nitadori, J. I.; Sima, C. S.; Ujiie, H.; Rizk, N. P.; Jones, D. R.; Adusumilli, P. S.; Travis, W. D.
Article Title:	Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small Stage I lung adenocarcinomas
Abstract:	Introduction: Tumor invasion in lung adenocarcinoma is defined as infiltration of stroma, blood vessels, or pleura. Based on observation of tumor spread through air spaces (STAS), we considered whether this could represent new patterns of invasion and investigated whether it correlated with locoregional versus distant recurrence according to limited resection versus lobectomy. Methods: We reviewed resected small (less than or equal to 2 cm) stage I lung adenocarcinomas (n = 411; 1995-2006). Tumor STAS was defined as tumor cells - micropapillary structures, solid nests, or single cells - spreading within air spaces in the lung parenchyma beyond the edge of the main tumor. Competing risks methods were used to estimate risk of disease recurrence and its associations with clinicopathological risk factors. Results: STAS was observed in 155 cases (38%). In the limited resection group (n = 120), the risk of any recurrence was significantly higher in patients with STAS-positive tumors than that of patients with STAS-negative tumors (5-year cumulative incidence of recurrence, 42.6% versus 10.9%; P < 0.001); the presence of STAS correlated with higher risk of distant (P = 0.035) and locoregional recurrence (P = 0.001). However, in the lobectomy group (n = 291), the presence of STAS was not associated with either any (P = 0.50) or distant recurrence (P = 0.76). In a multivariate analysis, the presence of tumor STAS remained independently associated with the risk of developing recurrence (hazard ratio, 3.08; P = 0.014). Conclusion: The presence of STAS is a significant risk factor of recurrence in small lung adenocarcinomas treated with limited resection. These findings support our proposal that STAS should formally be recognized as a pattern of invasion in lung adenocarcinoma. © 2015 by the International Association for the Study of Lung Cancer.
Keywords:	adult; human tissue; aged; cancer surgery; major clinical study; clinical feature; cancer localization; cancer recurrence; cancer risk; cancer patient; adenocarcinoma; metastasis; lung lobectomy; lung resection; recurrence; retrospective study; risk assessment; lung adenocarcinoma; lung; intermethod comparison; invasion; tumor invasion; human; male; female; priority journal; article; spread through air spaces; tumor spread through air space
Journal Title:	Journal of Thoracic Oncology
Volume:	10
Issue:	5
ISSN:	1556-0864
Publisher:	Elsevier Inc.
Date Published:	2015-05-01
Start Page:	806
End Page:	814
Language:	English
DOI:	10.1097/jto.0000000000000486
PROVIDER:	scopus
PUBMED:	25629637
PMCID:	PMC4500042
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84938286585&partnerID=40&md5=3b219ec69d225007f41e73ce754bee35
Notes:	Export Date: 2 September 2015 -- Source: Scopus

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