Takashi Eguchi1, Koji Kameda2, Shaohua Lu3, Matthew J Bott4, Kay See Tan5, Joseph Montecalvo6, Jason C Chang6, Natasha Rekhtman6, David R Jones4, William D Travis6, Prasad S Adusumilli7. 1. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Thoracic Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan. 2. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Thoracic Surgery, National Defense Medical College, Tokorozawa, Japan. 3. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. 4. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. 5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. 6. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York. 7. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: adusumip@mskcc.org.
Abstract
INTRODUCTION: Spread through air spaces (STAS) is a form of invasion wherein tumor cells extend beyond the tumor edge within the lung parenchyma. In lung adenocarcinoma (ADC), we investigated the (1) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (2) effect of surgical margin-to-tumor diameter ratio in STAS-positive patients, and (3) potential utility of frozen sections (FSs) for detecting STAS intraoperatively. METHODS: We investigated 1497 patients who underwent lobectomy (n = 970) or sublobar resection (n = 527) for T1N0M0 lung ADC after propensity score matching. Outcomes were analyzed by using a competing risks approach. The effect of margin-to-tumor ratio on recurrence pattern (locoregional and distant) was investigated in patients who underwent sublobar resection. Five pathologists evaluated the feasibility of intraoperatively identifying STAS by using FSs (sensitivity, specificity, and interrater reliability). RESULTS: On multivariable analysis after propensity score matching (349 pairs/procedure), sublobar resection was significantly associated with recurrence (subhazard ratio = 2.84 [p < 0.001]) and lung cancer-specific death (subhazard ratio = 2.63 [p = 0.021]) in patients with STAS but not in those without STAS. Patients with STAS who underwent sublobar resection had a higher risk of locoregional recurrence regardless of margin-to-tumor ratio (for a margin-to-tumor ratio of ≥1 versus <1, the 5-year cumulative incidence of recurrence rates were 16% and 25%, respectively); among patients without STAS, locoregional recurrences occurred in patients with margin-to-tumor ratio lower than 1 (a 5-year cumulative incidence of recurrence rate of 7%). The sensitivity and specificity for detecting STAS by use of FSs were 71% and 92%, with substantial interrater reliability (Gwet's AC1, 0.67). CONCLUSIONS: In patients with T1 lung ADC with STAS, lobectomy was associated with better outcomes than sublobar resection was. Pathologists can recognize STAS on FSs.
INTRODUCTION: Spread through air spaces (STAS) is a form of invasion wherein tumor cells extend beyond the tumor edge within the lung parenchyma. In lung adenocarcinoma (ADC), we investigated the (1) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (2) effect of surgical margin-to-tumor diameter ratio in STAS-positive patients, and (3) potential utility of frozen sections (FSs) for detecting STAS intraoperatively. METHODS: We investigated 1497 patients who underwent lobectomy (n = 970) or sublobar resection (n = 527) for T1N0M0 lung ADC after propensity score matching. Outcomes were analyzed by using a competing risks approach. The effect of margin-to-tumor ratio on recurrence pattern (locoregional and distant) was investigated in patients who underwent sublobar resection. Five pathologists evaluated the feasibility of intraoperatively identifying STAS by using FSs (sensitivity, specificity, and interrater reliability). RESULTS: On multivariable analysis after propensity score matching (349 pairs/procedure), sublobar resection was significantly associated with recurrence (subhazard ratio = 2.84 [p < 0.001]) and lung cancer-specific death (subhazard ratio = 2.63 [p = 0.021]) in patients with STAS but not in those without STAS. Patients with STAS who underwent sublobar resection had a higher risk of locoregional recurrence regardless of margin-to-tumor ratio (for a margin-to-tumor ratio of ≥1 versus <1, the 5-year cumulative incidence of recurrence rates were 16% and 25%, respectively); among patients without STAS, locoregional recurrences occurred in patients with margin-to-tumor ratio lower than 1 (a 5-year cumulative incidence of recurrence rate of 7%). The sensitivity and specificity for detecting STAS by use of FSs were 71% and 92%, with substantial interrater reliability (Gwet's AC1, 0.67). CONCLUSIONS: In patients with T1 lung ADC with STAS, lobectomy was associated with better outcomes than sublobar resection was. Pathologists can recognize STAS on FSs.
Authors: Raj G Vaghjiani; Yusuke Takahashi; Takashi Eguchi; Shaohua Lu; Koji Kameda; Zachary Tano; Jordan Dozier; Kay See Tan; David R Jones; William D Travis; Prasad S Adusumilli Journal: J Thorac Oncol Date: 2020-01-30 Impact factor: 15.609
Authors: John T Poirier; Julie George; Taofeek K Owonikoko; Anton Berns; Elisabeth Brambilla; Lauren A Byers; David Carbone; Huanhuan J Chen; Camilla L Christensen; Caroline Dive; Anna F Farago; Ramaswamy Govindan; Christine Hann; Matthew D Hellmann; Leora Horn; Jane E Johnson; Young S Ju; Sumin Kang; Mark Krasnow; James Lee; Se-Hoon Lee; Jonathan Lehman; Benjamin Lok; Christine Lovly; David MacPherson; David McFadden; John Minna; Matthew Oser; Keunchil Park; Kwon-Sik Park; Yves Pommier; Vito Quaranta; Neal Ready; Julien Sage; Giorgio Scagliotti; Martin L Sos; Kate D Sutherland; William D Travis; Christopher R Vakoc; Sarah J Wait; Ignacio Wistuba; Kwok Kin Wong; Hua Zhang; Jillian Daigneault; Jacinta Wiens; Charles M Rudin; Trudy G Oliver Journal: J Thorac Oncol Date: 2020-02-01 Impact factor: 15.609
Authors: Rania G Aly; Natasha Rekhtman; Xiaoyu Li; Yusuke Takahashi; Takashi Eguchi; Kay See Tan; Charles M Rudin; Prasad S Adusumilli; William D Travis Journal: J Thorac Oncol Date: 2019-05-20 Impact factor: 15.609