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Prognostic Significance of Spread Through Air Spaces in Stage Ia/bN0 NSCLC-An Evaluation in the JCOG0802/WJOG4607L
Yasushi Yatabe1, Mary Beth Beasley2, Alain Borczuk3
1Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.
Introduction:
Tumor spread through air spaces (STAS) and histologic tumor grade have been reported as adverse prognostic factors in NSCLC, yet their impact on the extent of surgical resection remains insufficiently defined. This study aimed to evaluate the prognostic effects of STAS and tumor grade in patients with stage IA NSCLC (pT1a/bN0) from JCOG0802/WJOG4607L comparing segmentectomy with lobectomy.
Methods:
STAS and tumor grading were assessed in 593 tumors by 32 expert pulmonary pathologists worldwide. The prognostic impact of STAS in lobectomy (n = 294) versus segmentectomy (n = 299) was evaluated in relation to relapse-free survival (RFS) and overall survival (OS), including the association of STAS with histologic grading.
Results:
STAS was identified in 227 cases (38.3%) and was significantly associated with shorter RFS and OS (RFS: hazard ratio = 2.204; OS: hazard ratio = 1.917; both p < 0.001). Multivariable analysis confirmed STAS as an independent adverse factor for RFS (p < 0.001) and OS (p = 0.009). STAS was associated with higher local recurrence in both lobectomy and segmentectomy approaches (p = 0.012 and p = 0.002, respectively). STAS independently predicted shorter RFS in both lobectomy and segmentectomy subgroups but predicted OS only in the lobectomy subgroup. Among invasive nonmucinous adenocarcinomas, histologic grade 3 was strongly associated with STAS (p < 0.001) and poor outcomes. Both STAS and grade 3 independently predicted shorter RFS, whereas only grade 3 predicted OS.
Conclusions:
These findings reinforce STAS and high-grade adenocarcinoma as clinically significant prognostic factors and support their incorporation into risk stratification for patients with stage IA (pT1a/bN0) NSCLC.
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