通过气道播散的肺腺癌复发分析

SCI

3 March 2023

Analysis of Recurrence in Lung Adenocarcinoma with Spread Through Air Spaces

(The Journal of Thoracic and Cardiovascular Surgery, IF: 6.439)

Hassan A. Khalil, MD, Weiwei Shi, MD, Emanuele Mazzola, PhD, Daniel Nahum Lee,

BS, Emily Norton-Hughes, Daniel Dolan, MD, Samantha Corman, Abby White, DO,

Lynette M. Sholl, MD, Scott J. Swanson, MD

CORRESPONDENCE TO: hakhalil@bwh.harvard.edu.

Objectives 目的  

Spread through air spaces (STAS) 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 STAS portending worse outcomes are still under investigation. We reviewed our lung cancer experience to define potential factors related to STAS which influence recurrence and survival.

通过气道播散（STAS）定义为远离肺癌肿瘤边缘的气道区域中的肿瘤细胞。它与肺腺癌的局部较高的复发率和较低的生存率有关。目前仍在调查，出现STAS特征则预示着肺癌患者更糟糕的预后。我们回顾了肺癌的治疗经验，以确定与STAS相关的复发和生存的潜在相关因素。

Methods 方法  

Between January 2010 and December 2017, we identified 968 patients who underwent resection for T1-3N0M0 lung adenocarcinoma. Of these, histologic examination was possible on 787. We examined the presence of STAS, STAS characteristics (micropapillary, solid nest, or single cell), average density (number per slide), and farthest distance from tumor at which STAS was detected, or maximal spread distance (MSD). Overall survival (OS) and recurrence-free survival were estimated using Kaplan-Meier curves, and differences between STAS+ versus STAS– groups were assessed using the logrank test, with a p value threshold for significance equal to 0.05.

我们明确了在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。使用Kaplan-Meier曲线估计总生存期（OS）和无复发生存期，并使用logrank检验评估STAS+与STAS-组之间的差异，显着性的p值阈值等于0.05。

Results 结果  

STAS was present in 389/787 of the reviewed cases (49.4%). OS and recurrence-free survival were significantly lower in the STAS+ group over 10 years (p<0.0001). The incidences of locoregional and distant recurrence were nearly doubled over 10 years in the STAS+ group compared to the STAS– group (p=0.002 and <0.0001, respectively). In a multivariable Cox regression model adjusted for STAS characteristics, distance and tumor size, lobar resection did not confer survival advantage in patients with STAS (hazard ratio of sublobar resection with respect to lobar resection: 1.44 [95% CI: 0.98-2.11], p=0.067). In the STAS+ group, STAS density was 2.7 ± 1.4 clusters per slide and the MSD was 2.2 ± 1.7 mm from the tumor edge. There was no observed correlation between STAS density or MSD and OS or recurrence.

STAS在389/787例患者中出现（49.4%）。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。

Conclusions 结论  

We show increased distant recurrence in STAS+ lung adenocarcinoma. Quantifiable measures of STAS do not appear to correlate with recurrence or survival metrics.

我们的研究显示STAS+肺腺癌的远处复发增加。STAS的可量化测量似乎与复发或生存指标无关。