Combination of grade and spread through air spaces (STAS) predicts recurrence in early stage lung adenocarcinoma: a retrospective cohort study

Betul Bahar Isgir ¹, Gokhan Kocaman ², Yusuf Kahya ²

⁰Department of Thoracic Surgery, Ankara University, 06230, Ankara, Turkey. bhrkzk@hotmail.com.

Updates in Surgery +

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November 3, 2024

View abstract on PubMed

Summary

High-grade tumors and spread through air spaces (STAS) predict recurrence in early lung adenocarcinoma. Combining IASLC Grade 3 and STAS positivity identifies patients needing intensified adjuvant treatment for better outcomes.

Area Of Science

Oncology
Pathology
Surgical Oncology

Background

Lung adenocarcinomas are a major subtype of lung cancer with varied histology.
The International Association for the Study of Lung Cancer (IASLC) grading system highlights high-grade components for prognostic assessment.
Spread Through Air Spaces (STAS) is an emerging prognostic marker associated with increased lung cancer recurrence risk.

Purpose Of The Study

To investigate the combined prognostic impact of IASLC grading and STAS status in Stage I lung adenocarcinoma.
To identify high-risk patient groups for potential targeted adjuvant therapies.

Main Methods

Retrospective analysis of 123 patients with Stage I lung adenocarcinoma undergoing lobectomy.
Histological assessment using IASLC criteria and documentation of STAS status.
Survival analysis using Kaplan-Meier estimates and Cox proportional hazards models.

Main Results

STAS positivity was observed in 52.8% of patients and significantly correlated with IASLC Grade 3 tumors (p < 0.001).
STAS-positive patients exhibited significantly lower 5-year recurrence-free survival (70.7% vs. 88.7%, p = 0.026).
Patients with both Grade 3 and STAS positivity showed the poorest recurrence-free survival (p = 0.002) and were independent predictors of poor prognosis.

Conclusions

IASLC Grade 3 and STAS positivity are independent prognostic factors for reduced recurrence-free survival in Stage I lung adenocarcinoma.
These factors can help stratify risk and guide treatment decisions.
Consideration of adjuvant treatment strategies for patients with both Grade 3 and STAS positivity is recommended to improve outcomes.

Keywords:

STAS histologic subtype lung adenocarcinoma tumor grading