Patricia M Castro, Joana Rei, Cátia Silva, José Miranda, Miguel Guerra
{"title":"Spreading Through Air Spaces And Thinking About Lung Metastases.","authors":"Patricia M Castro, Joana Rei, Cátia Silva, José Miranda, Miguel Guerra","doi":"10.48729/pjctvs.325","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Spread through air spaces (STAS) is a novel pattern of invasion in primary lung cancers, which was introduced in the 2015 World Health Organization classification. Several studies have validated STAS to be a predictor of clinical outcome in lung adenocarcinoma. However, little is known about STAS as a mode of intraparenchymal diffusion of pulmonary metastases (PMs).</p><p><strong>Objectives: </strong>The aim of this study was to investigate the incidence of STAS among PMs and the association between STAS and clinicopathological characteristics of PMs.</p><p><strong>Methods: </strong>From August 1, 2017 to July 31, 2022, 50 patients underwent pulmonary metastectomy in our center. Clinicopathological characteristics of patients were retrospectively evaluated. Continuous variables were compared by using unpaired Students t-test or MannWhitney test, as appropriate. Categorical variables were compared by using Qui-squared test or Fishers exact test as appropriate.</p><p><strong>Results: </strong>A total of 50 patients with PMs who underwent surgical resection were analyzed, 68% being male. The median age of the study population was 60 years (range 24-80). Most patients had primary cancer originating from epithelial tissue (n=45) and the remaing from mesenchymal tissue (n=5). Colorectal cancer was the most frequent primary site of PMs (n= 32), followed by kidney (n=4) and osteosarcoma (n=3). 60% of patients (n=30) underwent sublobar resection (wedge resection or anatomic segmentectomy). STAS was observed in 10 patients (20%): 7 patients with PMs from CRC, 1 with PM from palatine tonsil, 1 from kidney and 1 from uterus. STAS was more frequent in elder patients (62 years, SD=7.099 vs 60 years, SD= 13.889; p = 0.034). Notably, STAS was significantly more frequent in PMs with larger dimension (2.8 cm, SD=2.049 vs 2.03 SD=1.104; p = 0.010), patients with lymph node metastases (p = 0.004) and in patients who underwent lobectomy rather than sublobar resection (70% vs 32.5%; p = 0.03). Although without statistically significant difference, locorregional recurrence and mortality was higher in patients with STAS+ (40% vs 22.5% and 40% vs 20%, respectively).</p><p><strong>Conclusion: </strong>VSTAS is nowadays considered to be a lung-specific tumour invasion pattern and is commonly observed in PMs of different origins.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"31-35"},"PeriodicalIF":0.0000,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Portuguese journal of cardiac thoracic and vascular surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.48729/pjctvs.325","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Spread through air spaces (STAS) is a novel pattern of invasion in primary lung cancers, which was introduced in the 2015 World Health Organization classification. Several studies have validated STAS to be a predictor of clinical outcome in lung adenocarcinoma. However, little is known about STAS as a mode of intraparenchymal diffusion of pulmonary metastases (PMs).
Objectives: The aim of this study was to investigate the incidence of STAS among PMs and the association between STAS and clinicopathological characteristics of PMs.
Methods: From August 1, 2017 to July 31, 2022, 50 patients underwent pulmonary metastectomy in our center. Clinicopathological characteristics of patients were retrospectively evaluated. Continuous variables were compared by using unpaired Students t-test or MannWhitney test, as appropriate. Categorical variables were compared by using Qui-squared test or Fishers exact test as appropriate.
Results: A total of 50 patients with PMs who underwent surgical resection were analyzed, 68% being male. The median age of the study population was 60 years (range 24-80). Most patients had primary cancer originating from epithelial tissue (n=45) and the remaing from mesenchymal tissue (n=5). Colorectal cancer was the most frequent primary site of PMs (n= 32), followed by kidney (n=4) and osteosarcoma (n=3). 60% of patients (n=30) underwent sublobar resection (wedge resection or anatomic segmentectomy). STAS was observed in 10 patients (20%): 7 patients with PMs from CRC, 1 with PM from palatine tonsil, 1 from kidney and 1 from uterus. STAS was more frequent in elder patients (62 years, SD=7.099 vs 60 years, SD= 13.889; p = 0.034). Notably, STAS was significantly more frequent in PMs with larger dimension (2.8 cm, SD=2.049 vs 2.03 SD=1.104; p = 0.010), patients with lymph node metastases (p = 0.004) and in patients who underwent lobectomy rather than sublobar resection (70% vs 32.5%; p = 0.03). Although without statistically significant difference, locorregional recurrence and mortality was higher in patients with STAS+ (40% vs 22.5% and 40% vs 20%, respectively).
Conclusion: VSTAS is nowadays considered to be a lung-specific tumour invasion pattern and is commonly observed in PMs of different origins.
导言:通过气隙扩散(STAS)是原发性肺癌的一种新的侵袭模式,在 2015 年世界卫生组织的分类中被引入。多项研究证实,STAS 是肺腺癌临床预后的预测指标。然而,人们对STAS作为肺转移瘤(PMs)实质内扩散的一种模式知之甚少:本研究旨在调查STAS在肺转移瘤中的发生率以及STAS与肺转移瘤临床病理特征之间的关联:方法:2017年8月1日至2022年7月31日,50名患者在我中心接受了肺转移瘤切除术。对患者的临床病理特征进行了回顾性评估。连续变量的比较采用非配对学生 t 检验或 MannWhitney 检验(视情况而定)。分类变量的比较视情况采用奎方检验或菲舍尔精确检验:共分析了50名接受手术切除的原发性骨髓瘤患者,其中68%为男性。研究对象的中位年龄为 60 岁(24-80 岁不等)。大多数患者的原发癌源自上皮组织(45 人),其余来自间质组织(5 人)。大肠癌是原发性骨髓瘤最常见的原发部位(32人),其次是肾癌(4人)和骨肉瘤(3人)。60%的患者(n=30)接受了肺叶下切除术(楔形切除术或解剖分段切除术)。10名患者(20%)观察到STAS:其中7例患者的肿瘤来自CRC,1例来自腭扁桃体,1例来自肾脏,1例来自子宫。STAS在老年患者中更为常见(62岁,SD=7.099 vs 60岁,SD=13.889;P=0.034)。值得注意的是,STAS在肿瘤尺寸较大(2.8厘米,SD=2.049 vs 2.03,SD=1.104;P=0.010)、有淋巴结转移(P=0.004)以及接受肺叶切除术而非肺叶下切除术的患者中的发生率明显更高(70% vs 32.5%;P=0.03)。STAS+患者的局部区域复发率和死亡率较高(分别为40% vs 22.5%和40% vs 20%),但差异无统计学意义:结论:VSTAS如今被认为是一种肺部特异性肿瘤侵袭模式,常见于不同来源的肺癌。