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Sublobar Resection in Stage I Lung Cancer With Tumor Spread Through Air Spaces
Andrea L Axtell1, Brittany Walker1, Joshua R Brady1
1Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Annals of Thoracic Surgery Short Reports
|October 30, 2025
Summary
Tumor spread through air spaces (STAS) in stage I lung cancer patients undergoing sublobar resection is linked to poorer survival. However, STAS does not impact survival outcomes following lobectomy for stage I lung cancer.
Area of Science:
- Oncology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Sublobar resection is a common treatment for early-stage lung cancer.
- The impact of tumor spread through air spaces (STAS) on survival after sublobar resection is not well understood.
Purpose of the Study:
- To investigate the association between STAS and survival outcomes in patients with stage I lung cancer undergoing resection.
- To compare survival rates based on the presence of STAS and surgical approach (sublobar resection vs. lobectomy).
Main Methods:
- Retrospective cohort analysis of 421 patients who underwent lung cancer resection (2018-2022).
- Comparison of baseline characteristics between patients with and without STAS.
- Survival and recurrence analyzed using Kaplan-Meier and Cox models.
Main Results:
- 23% of patients had STAS, which was associated with larger tumor size and lymphovascular invasion.
- Stage I patients with STAS undergoing sublobar resection had decreased overall survival (73% at 5 years) compared to those without STAS (87%).
- Lobectomy, regardless of STAS status, resulted in higher overall survival (90%) compared to sublobar resection in STAS-positive patients.
Conclusions:
- STAS is a significant prognostic factor in stage I lung cancer patients treated with sublobar resection.
- Sublobar resection for STAS-positive stage I lung cancer is associated with inferior survival outcomes.
- Lobectomy appears to be a more effective surgical strategy for stage I lung cancer patients, irrespective of STAS presence.
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