Spread through air spaces as a prognostic factor in resected non-small cell lung cancer

Yıl 2025, Cilt: 7 Sayı: 5, 569 - 575, 15.09.2025

Gül Sema Keskin , Gizem Yıldırım , Volkan Aslan , Elcin Kadan , Ersin Sapmaz , Musa Barış Aykan , İsmail Ertürk , Nuri Karadurmuş

https://doi.org/10.38053/acmj.1738996

Öz

Aims: To evaluate the prognostic impact of spread through air spaces (STAS) in patients with resected non-small cell lung cancer (NSCLC) and to investigate its association with clinicopathological features and survival outcomes.
Methods: A retrospective analysis was conducted on 207 patients with pathological stage IA–IIIA NSCLC who underwent curative-intent surgery between 2018 and 2024. STAS was defined as the presence of micropapillary clusters, solid nests, or single tumor cells within alveolar spaces beyond the main tumor. Patients were categorized as STAS-positive or STAS-negative. Disease free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Univariate and multivariate Cox regression models were used to assess prognostic factors.
Results: STAS was identified in 57% of patients. STAS positivity was significantly associated with poor differentiation, a higher rate of lymphovascular invasion, and increased use of adjuvant chemotherapy. Median DFS was 29.9 months in STAS-positive patients but was not reached in STAS-negative patients (p<0.001). In multivariable analysis, STAS independently predicted shorter DFS (HR: 2.38; 95% CI: 1.34–4.23; p=0.003). No statistically significant association was found between STAS and OS (p=0.079).
Conclusion: STAS is an independent adverse prognostic factor for DFS in resected NSCLC. Its presence should be considered in prognostic evaluation and surgical planning, particularly in patients with early-stage disease.

Anahtar Kelimeler

Non-small cell lung cancer , STAS , disease-free survival , prognostic factors , surgery

Etik Beyan

This study was approved by the Gulhane Scientific Research Ethics Committee (approval number: 2025-275; date of approval: 06 May 2025). Due to the retrospective nature of the study and the use of de-identified data, informed consent was waived in accordance with institutional and national ethical guidelines.

Proje Numarası

2025-275 (06.05.2025)

Rezeke edı̇len küçük hücrelı̇ dışı akcı̇ğer kanserı̇nde prognostı̇k bı̇r faktör olarak hava boşluklarına yayılım

Öz

Amaç: Bu çalışmanın amacı, rezeke edilmiş küçük hücreli dışı akciğer kanseri (KHDAK) hastalarında hava boşlukları yoluyla yayılımın (STAS) prognostik etkisini değerlendirmek ve STAS’ın klinikopatolojik özellikler ile sağkalım sonuçlarıyla ilişkisini araştırmaktır.

Yöntemler: 2018–2024 yılları arasında küratif amaçlı cerrahi uygulanan patolojik evre IA–IIIA KHDAK tanılı 207 hastanın verileri retrospektif olarak analiz edildi. STAS, ana tümör sınırları dışında alveoler boşluklarda mikropapiller kümeler, solid adacıklar veya tekil tümör hücrelerinin varlığı olarak tanımlandı. Hastalar STAS-pozitif ve STAS-negatif olarak sınıflandırıldı. Hastalıksız sağkalım (DFS) ve genel sağkalım (OS), Kaplan–Meier yöntemi ile hesaplandı. Prognostik faktörler, univaryant ve multivaryant Cox regresyon analizleri ile değerlendirildi.

Bulgular: Hastaların %57’sinde STAS pozitifliği saptandı. STAS pozitifliği; kötü diferansiasyon, artmış lenfovasküler invazyon ve adjuvan kemoterapi kullanım oranı ile anlamlı şekilde ilişkiliydi. STAS pozitif hastalarda medyan DFS 29.9 ay iken, STAS negatif hastalarda medyan DFS’ye ulaşılamadı (p < 0.001). Multivaryant analizde STAS, hastalıksız sağkalım için bağımsız bir kötü prognostik faktör olarak belirlendi (HR: 2.38; %95 GA: 1.34–4.23; p = 0.003). STAS ile genel sağkalım arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p = 0.079).

Sonuç: STAS, rezeke edilmiş KHDAK hastalarında hastalıksız sağkalımı olumsuz yönde etkileyen bağımsız bir prognostik faktördür. Erken evre hastalar başta olmak üzere, STAS varlığı prognostik değerlendirme ve cerrahi planlamada dikkate alınmalıdır.

Anahtar Kelimeler

Küçük hücreli dışı akciğer kanseri , STAS , hastalıksız sağkalım , prognostik faktörler

Proje Numarası

2025-275 (06.05.2025)

Kaynakça

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