Lobectomy Is Associated with Better Outcomes than Sublobar Resection in Spread through Air Spaces (STAS)-Positive T1 Lung Adenocarcinoma: A Propensity Score-Matched Analysis.
Lobectomy Is Associated with Better Outcomes than Sublobar Resection in Spread through Air Spaces (STAS)-Positive T1 Lung Adenocarcinoma: A Propensity Score-Matched Analysis.
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DOI：
10.1016/j.jtho.2018.09.005
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发表时间：
2019-01
期刊：
影响因子：
--
通讯作者：
Adusumilli PS
中科院分区：
文献类型：
--
作者：
Eguchi T;Kameda K;Lu S;Bott MJ;Tan KS;Montecalvo J;Chang JC;Rekhtman N;Jones DR;Travis WD;Adusumilli PS
气隙扩散（STAS）是一种侵袭形式，其中肿瘤细胞在肺实质内延伸超过肿瘤边缘。在肺腺癌（ADC）中，我们研究了（a）STAS与手术特异性结局（肺叶切除术和肺叶切除术）之间的关系，（B）STAS阳性患者手术切缘/肿瘤直径比的影响，以及（c）术中检测STAS的冷冻切片（FS）的潜在效用。我们研究了1497例接受肺叶切除术（n=970）或肺叶下切除术（n=527）的T1 N 0 M0肺ADC患者，遵循倾向评分匹配。使用竞争风险方法分析结果。在肺叶下患者中研究了切缘/肿瘤比对复发模式（局部和远处）的影响。五位病理学家评价了术中使用FS识别STAS的可行性（敏感性、特异性、评估者间可靠性）。根据倾向评分匹配的多变量分析（349对/手术），在STAS患者中，肺叶切除术与复发（亚危险比，2.84; P<0.001）和肺癌特异性死亡（亚危险比，2.63; P=0.021）显著相关，而在无STAS患者中则无相关性。接受肺叶下切除术的STAS患者无论切缘/肿瘤比如何，局部区域复发的风险都更高（切缘/肿瘤比≥1与<1：5年累积复发率[CIR]，16%和25%）;在未接受STAS的患者中，切缘/肿瘤比<1的患者局部区域复发发生率（5年CIR，7%）。FS检测STAS的敏感性和特异性分别为71%和92%，评价者间可靠性较高（Gwet’s AC 1，0.67）。在T1肺ADC伴STAS患者中，肺叶切除术的结局优于肺叶下切除术。病理学家可以在FS上识别STAS。
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 (a) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (b) effect of surgical margin/tumor diameter ratio in STAS-positive patients, and (c) potential utility of frozen section (FS) for detecting STAS intraoperatively. We investigated 1497 patients who underwent lobectomy (n=970) or sublobar resection (n=527) for T1N0M0 lung ADC, following propensity-score matching. Outcomes were analyzed using a competing-risks approach. The effect of margin/tumor ratio on recurrence pattern (locoregional and distant) was investigated in sublobar patients. Five pathologists evaluated the feasibility of intraoperatively identifying STAS using FS (sensitivity, specificity, interrater reliability). On multivariable analysis following 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/tumor ratio (margin/tumor ratio ≥1 vs. <1: 5-year cumulative incidence of recurrence [CIR], 16% and 25%); among patients without STAS, locoregional recurrences occurred in patients with margin/tumor ratio <1 (5-year CIR, 7%). Sensitivity and specificity for detecting STAS by FS were 71% and 92%, with substantial interrater reliability (Gwet’s AC1, 0.67). In T1 lung ADC patients with STAS, lobectomy was associated with better outcomes than sublobar resection. Pathologists can recognize STAS on FS.
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影响因子：
6
作者：
Koike, T;Yamato, Y;Suzuki, R
通讯作者：
Suzuki, R
影响因子：
4.6
作者：
Kodama, Ken;Higashiyama, Masahiko;Kuriyama, Keiko
通讯作者：
Kuriyama, Keiko
影响因子：
45.3
作者：
Landreneau, Rodney J.;Normolle, Daniel P.;Schuchert, Matthew J.
通讯作者：
Schuchert, Matthew J.
DOI：
10.1158/1078-0432.ccr-11-2097
发表时间：
2012-04-15
期刊：
Clinical cancer research : an official journal of the American Association for Cancer Research
影响因子：
--
作者：
Dignam JJ;Zhang Q;Kocherginsky M
通讯作者：
Kocherginsky M
影响因子：
4.6
作者：
Koike, Terumoto;Kitahara, Akihiko;Tsuchida, Masanori
通讯作者：
Tsuchida, Masanori