Spread through air spaces affects survival and recurrence of patients with clinical stage IA non-small cell lung cancer after wedge resection.

Abstract

BackgroundSpread through air spaces (STAS) is reportedly a significant risk factor for recurrence and a prognostic factor in patients with non-small cell lung cancer (NSCLC), especially after sublobar resection. Because wedge resection (WR) is associated with insufficient margins, we hypothesized that STAS has a greater prognostic impact in patients who undergo WR compared with segmentectomy. We aimed to clarify the value of STAS as a prognostic factor in patients with NSCLC after WR.MethodsWe evaluated 217 patients with clinical stage IA NSCLC who underwent sublobar resection. The prognostic impact of STAS in these patients was compared between the WR (n=100) and segmentectomy (n=117) cases.ResultsSTAS was present in 15.7% of the 217 patients. STAS was a significant prognostic factor for overall survival in univariate (P<0.001) and multivariate (P=0.003) analyses for the WR cases, but not the segmentectomy cases (P=0.399). STAS was also a significant prognostic factor for freedom from recurrence in univariate (P=0.010) and multivariate (P=0.024) analyses for the WR cases, but was only marginally significant for the segmentectomy cases (P=0.050, univariate analysis). The solid tumor size on chest computed tomography was significantly related to STAS. A cut-off solid tumor size of 1.7 cm for predicting the presence of STAS was determined by receiver operating characteristic analysis.ConclusionsSTAS was a significant prognostic factor for patients with clinical stage IA NSCLC who underwent WR, but not those who underwent segmentectomy.