Prognostic Impact of Margin Distance and Tumor Spread Through Air Spaces in Limited Resection for Primary Lung Cancer

doi:10.1016/j.jtho.2017.08.015

Journal of Thoracic Oncology

Volume 12, Issue 12, December 2017, Pages 1788-1797

https://doi.org/10.1016/j.jtho.2017.08.015 Get rights and content

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Abstract

Objectives

The aim of this study was to investigate the relationship between clinicopathological prognostic factors, including surgical margin distance and tumor spread through air spaces (STAS), and recurrence after limited resection for primary lung cancer.

Methods

We identified 508 cases of limited resection (12.8%) and examined their clinicopathological features. Using Cox regression analysis, we examined the significant prognostic factors for recurrence of limited resection. Finally, we conducted a histopathological evaluation of tumor STAS.

Results

Multivariate Cox analysis showed that the risk for local recurrence was significantly associated with STAS (hazard ratio = 12.24, p = 0.001) and a tumor margin less than 1.0 cm (hazard ratio = 6.36, p = 0.02). However, the presence of tumor STAS was not significantly associated with distant recurrence (p = 0.98). This lack of association of STAS with distant recurrence may be due to the small number of distant recurrences. In all, 76 cases (15.0%) (60 adenocarcinomas, nine squamous cell carcinomas, and seven others) were positive for STAS. The morphological STAS patterns were 12 single cells, 45 small cell clusters, and 19 large nests. There was no significant relationship between the recurrence rate and morphological STAS pattern. The STAS-positive group was associated with the presence of micropapillary (p = 0.002) and/or solid components (p = 0.008) in patients with adenocarcinoma and with lymphovascular and pleural invasion (p < 0.001).

Conclusions

The presence of STAS and tumor margins less than 1.0 cm are significant risk factors for local recurrence in early-stage lung cancer after limited resection. Thus, the presence of tumor STAS might be a pathological prognostic factor for patients with lung cancer who have undergone limited resection. However, the pathological and molecular significance of STAS remain to be clarified.

Keywords

Lung cancer

Tumor spread through air spaces

STAS

Tumor margin

Limited resection

Local recurrence

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: Disclosure: Dr. Motoi reports personal fees from Taiho Pharmaceutical, Chugai Pharmaceutical, Microsystems, Novartis Pharma, Bristol-Myers Squibb, Ono Pharmaceutical, Agilent Technologies, and AstraZeneca outside the submitted work. Dr. Asamura reports grants from Eli Lilly Japan, Pfizer Japan, Shionogi, Ono Pharmaceutical, Tsumura, Taiho Pharmaceutical, Meiji Seika Pharma, and Astellas Pharma, and personal fees from Covidien Japan, Johnson and Johnson, and Innomedics Medical Instruments outside the submitted work. The remaining authors declare no conflict of interest.