Tumor Spread Through Air Spaces in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

A series of studies have assessed the clinicopathological features and prognostic impact of spread through air spaces (STAS) in non-small cell lung cancer (NSCLC) bringing conflicting findings so far. We performed a systematic review and meta-analysis to synthesize the available evidence regarding to the prognostic value of STAS in NSCLCs.

METHODS:

Studies were identified by searching databases including PubMed, EMBASE, Web of Science, and Cochrane Library up to August 2018 without language restrictions. Results of these searches were filtered according to a set of eligibility criteria and analyzed in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS:

A total of 3,754 patients from 14 studies were selected for the present study. The pooled results suggested that presence of STAS was associated with worse recurrence-free survival (hazard ratio [HR], 1.975; 95% confidence interval [CI], 1.691 to 2.307; p < 0.001) and overall survival (HR, 1.75; 95% CI, 1.375 to 2.227; p < 0.001) in NSCLCs. Subgroup analysis by histology type indicated the presence of STAS was significantly associated with inferior recurrence-free survival in resected lung adenocarcinoma (n = 7; HR, 2.288; 95% CI, 1.843 to 2.840; I2 = 7.80%), lung squamous cell carcinoma (n = 3; HR, 1.622; 95% CI, 1.279 to 2.056; I2 = 0%), and lung pleomorphic carcinoma (n = 1; HR, 4.76; 95% CI, 1.168 to 19.398). Additionally, a number of clinicopathological characteristics indicating STAS in NSCLCs are summarized.

CONCLUSIONS:

Our study indicates that tumor STAS was a potentially significant prognostic predictor for surgical patients with NSCLCs. The prognostic impact of STAS present in the resection margin remains undetermined. Further large-scale prospective studies are warranted to confirm the prognostic significance of STAS in patients with NSCLCs.

• Authors: Donglai Chen, Yiming Mao, Junmiao Wen, Yunlang She, Erjia Zhu, Feng Zhu, Yongsheng Zhang, Min Fan, Chang Chen, Yongbing Chen
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 108 Issue 3 Pg. 945-954 (09 2019) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 30914285 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Carcinoma, Non-Small-Cell Lung (mortality, pathology, therapy)
• Combined Modality Therapy
• Disease Progression
• Disease-Free Survival
• Female
• Humans
• Lung Neoplasms (mortality, pathology, therapy)
• Male
• Middle Aged
• Neoplasm Invasiveness (pathology)
• Neoplasm Metastasis (pathology)
• Neoplasm Recurrence, Local (mortality, physiopathology)
• Neoplasm Staging
• Prognosis
• Risk Assessment
• Survival Analysis