Abstract 135MO
Background
We evaluate the prognostic impact of the spread through air spaces (STAS) grading system in early-stage lung adenocarcinoma (LUAD).
Methods
We included patients who underwent lobectomy with lymphadenectomy and were diagnosed with stage I invasive nonmucinous LUAD. The extent of STAS was graded according to the distance from the edge of the tumor (Grade I:
Results
Among the 1660 patients, 375 (22.6%) were STAS grade I and 202 (12.2%) were STAS grade II. The STAS grade II group showed a higher proportion of pathologic stage IB (25.9% versus 38.3%, P=0.003) and micropapillary-solid predominant subtypes (18.4% versus 37.3%, P < 0.001) compared to the STAS grade I group. The median follow-up period was 59.5 months (inter-quantile range, 36.7–83.2 months). The 5-year cumulative incidence of any recurrence was 3.9% in the STAS (-) group, 8.4% in the STAS grade I group, and 17.0% in the STAS grade II group (P < 0.001). Multivariable competing risk regression analyses revealed that the STAS grading system was associated with an increased risk of any recurrence (STAS grade I, HR 1.08, 95% CI 0.66–1.78, P=0.76; STAS grade II, HR 1.94, 95% CI 1.10–3.42, P=0.022). In subgroup analysis stratified by pathologic stage, the cumulative incidence of any recurrence in the pathologic stage IA STAS grade II subgroup was comparable to that of the pathologic stage IB subgroup (IA, STAS grade II: 13.0%; IB, total: 16.0%; P value=0.8).
Table 135MO| HR | 95% CI | P value | |
| Age, years | 1.01 | 0.98–1.03 | 0.66 |
| Sex, male | 0.64 | 0.33–1.25 | 0.19 |
| Smoking, yes | 2.14 | 1.09–4.19 | 0.026 |
| ECOG, ≥2 | 1.62 | 0.91–2.86 | 0.1 |
| Predominant subtypes | |||
| Acinar-Papillary | 4.07 | 0.55–30.2 | 0.17 |
| Micropapillary-Solid | 6.51 | 0.83–51.0 | 0.075 |
| Invasive tumor size, cm | 1.39 | 1.06–1.82 | 0.016 |
| VPI, present | 2.04 | 1.25–3.32 | 0.004 |
| LVI, present | 1.7 | 1.08–2.66 | 0.022 |
| Necrosis, present | 1.45 | 0.87–2.44 | 0.15 |
| STAS grade | |||
| Grade I | 1.08 | 0.66–1.78 | 0.76 |
| Grade II | 1.94 | 1.10–3.42 | 0.022 |
Conclusions
The STAS grading system might be associated with an increased risk of recurrence in patients with pathologic stage IA LUAD who underwent lobectomy, but not those with pathologic stage IB. The STAS grade II in pathologic stage IA LUAD demonstrated a similar risk of recurrence to that of pathologic stage IB.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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