Computed tomography features of resected lung adenocarcinomas with spread through air spaces
Computed tomography features of resected lung adenocarcinomas with spread through air spaces
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DOI：
10.1016/j.jtcvs.2018.04.126
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发表时间：
2018-10-01
影响因子：
6
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Toyokawa, Gouji;Yamada, Yuichi;Maehara, Yoshihiko
背景资料：通过空气间隙扩散（STAS）是最近认识到的肺癌侵袭模式，定义为“微乳头簇、实性巢或单个细胞超出肿瘤边缘进入空气间隙”。由于STAS已被证明是术后生存的一个重要指标，术前通过计算机断层扫描（CT）预测STAS可能有助于确定最佳的外科手术程序。方法：327例肺腺癌切除患者的STAS和术前CT信息。STAS定义为肿瘤细胞位于主肿瘤边缘以外的肺实质中的气隙内。结果：327例手术切除的腺癌中，STAS阳性191例（58.4%），阳性率为100%。单变量分析显示，与STAS阴性腺癌相比，STAS阳性腺癌与较大的放射学肿瘤直径（P = 0.02）、血管会聚（P <0.01）、切迹（P <0.01）、胸膜凹陷（P = 0.03）、毛刺（P <0.01）和GGO缺失（P <0.01）显著相关。在多变量分析中，切迹的存在（P = .01）和GGO的缺失（P < .01）与STAS现象显著相关。Notch阳性和GGO阴性腺癌与Notch阴性和GGO阳性腺癌发生STAS的比值比为5.01（P <0.01）。结论：Notch的存在和GGO的缺失与STAS现象独立相关。这些结果将有助于术前CT鉴别STAS阳性腺癌。
Background: Spread through air spaces (STAS) is a recently recognized invasive pattern of lung cancer defined as "micropapillary clusters, solid nests, or single cells beyond the edge of the tumor into air spaces." Since STAS has been shown to be a significant prognosticator for the postoperative survival, predicting STAS preoperatively by computed tomography (CT) might help determine the optimum surgical procedures.Methods: Information on STAS and preoperative CT was available in 327 patients with resected lung adenocarcinomas. STAS was defined as tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor. The association of STAS with CT characteristics, such as vascular convergence, ground-glass opacity (GGO), air bronchogram, notch, pleural indentation, spiculation, and cavitation, was analyzed.Results: Among the 327 patients with resected adenocarcinoma, 191 (58.4%) were positive for STAS. A univariable analysis demonstrated that STAS-positive adenocarcinomas were significantly associated with a larger radiologic tumor diameter (P = .02), the presence of vascular convergence (P < .01), notch (P < .01), pleural indentation (P = .03), spiculation (P < .01), and the absence of GGO (P < .01) compared with STAS-negative ones. In a multivariable analysis, the presence of notch (P = .01) and the absence of GGO (P < .01) were shown to be significantly associated with the STAS phenomenon. The odds ratio for STAS of notch-positive and GGO-negative adenocarcinomas against notch-negative and GGO-positive ones was 5.01 (P < .01).Conclusions: The presence of notch and the absence of GGO were independently associated with the STAS phenomenon. These results will prove helpful in identifying STAS-positive adenocarcinoma by CT before surgical resection.