Sublobar Resection in Stage I Lung Cancer With Tumor Spread Through Air Spaces

Stage I lung cancer is increasingly being treated with sublobar resection. However, it is unknown whether patients with airspace invasion derive similar benefits. We therefore analyzed the association between tumor spread through air spaces (STAS) and survival.

A retrospective cohort analysis was conducted on 421 patients who underwent a lung cancer resection between 2018 and 2022 at an academic institution. Baseline characteristics were compared between patients who did and did not have STAS. Overall survival and disease recurrence were analyzed using Kaplan-Meier and Cox models.

Of 421 patients who underwent lung cancer resection, 97 (23%) had STAS. There was no difference in STAS based on comorbidities or pulmonary function, however, patients with STAS were more likely to have higher pack-year smoking histories (47 vs 40 years, P = .041). Patients with STAS were more likely to have adenocarcinoma (91% vs 78%, P = .049), larger tumor size (2.6 vs 2.2 cm, P = .016), and lymphovascular invasion (46% vs 32%, P = .012). In patients with stage I disease, those with STAS who underwent sublobar resection had decreased overall survival compared with those without STAS (P = .042) or those who underwent lobectomy, regardless of the presence or absence of STAS. Five-year overall survival was 73% for stage I patients with STAS who underwent sublobar resection compared with 87% in patients without STAS, and 90% in patients without STAS who underwent lobectomy.

In patients with stage I disease, STAS is associated with decreased overall survival in patients who undergo sublobar resection; however, STAS does not affect overall survival after lobectomy.