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Limited Resection Is Associated With a Higher Risk of Locoregional Recurrence than Lobectomy in Stage I Lung Adenocarcinoma With Tumor Spread Through Air Spaces

Kadota, Kyuichi MD*; Kushida, Yoshio MD*; Kagawa, Seiko MD*; Ishikawa, Ryou MD*; Ibuki, Emi MD*; Inoue, Kosuke MD*; Go, Tetsuhiko MD; Yokomise, Hiroyasu MD; Ishii, Tomoya MD; Kadowaki, Norimitsu MD; Haba, Reiji MD*

The American Journal of Surgical Pathology: August 2019 - Volume 43 - Issue 8 - p 1033–1041
doi: 10.1097/PAS.0000000000001285
Original Articles

A growing number of independent studies have validated spread through air spaces (STAS) to be a predictor of worse prognosis in lung adenocarcinoma. To investigate the prognostic significance of STAS according to types of surgery and locations of recurrence, and the association between STAS and anti-anaplastic lymphoma kinase (ALK) expression, we analyzed a series of 735 Japanese patients with resected lung adenocarcinoma, which was restaged according to the 8th edition of TNM staging system. STAS was defined as tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor. Tumors were classified according to the 2015 WHO lung tumor classification. Recurrence-free probability and overall survival were analyzed using the log-rank test and the Cox proportional hazards model. STAS was observed in 247 patients. STAS was more frequently identified in ALK-positive tumors (P=0.020). STAS was an independent prognostic factor of a worse recurrence-free probability in all patients (hazard ratio [HR]=5.33, P<0.001) and in stage I patients (HR=6.87, P<0.001). STAS was an independent prognostic factor of a worse overall survival in all patients (HR=2.32, P<0.001) and in stage I patients (HR=2.85, P<0.001). In stage I patients with STAS, compared with lobectomy, limited resection was associated with a significantly higher risk of any recurrence (P=0.010) and locoregional recurrence (P=0.002). We have demonstrated that, in lung adenocarcinoma with STAS, limited resection was associated with a significantly higher risk of recurrence (especially locoregional recurrence) than lobectomy was.

Departments of *Diagnostic Pathology, Faculty of Medicine

General Thoracic Surgery, Faculty of Medicine

Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan

Conflicts of Interest and Source of Funding: This work was supported, in part, by JSPS KAKENHI Grant Number JP16K21201. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Kyuichi Kadota, MD, Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kagawa 761-0793, Japan (e-mail:

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