Impact of Spread Through Air Spaces (STAS) on Recurrence and Surgical Trends in Stage I Non-Small Cell Lung Cancer: A Real-World Cohort Study.

Abstract

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, which remains a leading cause of cancer mortality worldwide. Early detection, particularly at Stage I, is critical for improving survival outcomes. Low-dose computed tomography (LDCT) has increased the detection of small asymptomatic tumors, resulting in an earlier diagnosis and facilitating less invasive surgical approaches such as segmentectomy and wedge resection, which preserve lung function while offering survival outcomes comparable to lobectomy. However, the risk factors for recurrence in Stage I NSCLC remain poorly understood. This retrospective study analyzed 1077 Stage I NSCLC patients treated at Kaohsiung Medical University Hospital from 2010 to 2022. Data including AJCC 7th and 8th editions staging, surgical interventions, and pathological features were analyzed. The proportion of Stage I cases increased significantly from 9.3% in 2010 to 33.8% in 2017, with Stage IA cases increasing from 12.1% in 2018 to 38.2% in 2022. Concurrently, the lobectomy rate decreased from 75% in 2010 to 43.6% in 2022, with more sublobar resections performed. Kaplan-Meier analysis found no significant differences in recurrence-free survival between lobectomy and sublobar resection with regional lymph node dissection. Cox regression identified spread through air spaces (STAS) as an independent risk factor for recurrence (hazard ratio 2.87, p = 0.006), along with male sex, larger tumor size, and visceral pleural invasion. These findings highlight the role of LDCT in early detection and the importance of tailored treatment strategies, particularly addressing STAS, to optimize recurrence-free survival and improve outcomes of patients with Stage I NSCLC.