ArticleJournal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer2019
Lobectomy Is Associated with Better Outcomes than Sublobar Resection in Spread through Air Spaces (STAS)-Positive T1 Lung Adenocarcinoma: A Propensity Score-Matched Analysis.
Article in Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 172 papers, 3 of them syntheses that pooled it.
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Who cites it
172 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Analysis of Individual Patient Data Demonstrates that Sublobar Resection Followed by Adjuvant Chemotherapy has Equivalent Prognosis to Lobectomy in Patients with Stage I NSCLC with Spread through Air Spaces.Annals of surgical oncology · 2026Pooled it
- Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.International journal of surgery (London, England) · 2025Pooled it
- The prognostic significance of tumor spread through air space in stage I lung adenocarcinoma.Thoracic cancer · 2022Pooled it
- Peritumoral radiomics features on preoperative thin-slice CT images can predict the spread through air spaces of lung adenocarcinoma.Scientific reports · 2022Trial
- Diagnostic performance of spectral CT quantitative parameters in predicting spread through air spaces of lung adenocarcinoma.Quantitative imaging in medicine and surgery · 2026Article
- Clinicopathological Significance of Extra-Alveolar Invasion in Lung Adenocarcinomas Treated With Sublobar Resection.Pathology international · 2026Article
- Article
- Spread through air spaces as a marker of nonlinear evolutionary trajectories in lung cancer: implications for the 9th edition TNM classification.Journal of pathology and translational medicine · 2026Article
- Ensemble machine learning classifiers based on computed tomography radiomics for predicting spread through air spaces in lung adenocarcinoma: a multicenter retrospective cohort study with transcriptomic interpretation.Quantitative imaging in medicine and surgery · 2026Article
- Prognostic Implications of Tumor Spread Through Air Spaces in Patients with Resected Lung Adenocarcinoma.Diagnostics (Basel, Switzerland) · 2026Article
- Local Recurrence After Lung Segmentectomy-Risk Factors and Future Directions: A Contemporary Review.Cancers · 2026Review
- Femtosecond label-free imaging: A rapid and reliable alternative for intraoperative pathological assessment in thoracic oncology.JTCVS open · 2026Article
- Dual-layer spectral CT for predicting spread through air spaces in lung adenocarcinoma: a dual-center study.European radiology · 2026Article
- Impact of Spread Through Air Spaces on Outcomes After Uniportal VATS Resection for Lung Adenocarcinoma: A Propensity Score-Matched Analysis.Journal of personalized medicine · 2026Article
- The Role of Histology in Predicting Spread Through Air Spaces (STAS) in Non-Small Cell Lung Cancer.Journal of personalized medicine · 2026Article
- Spread through air spaces as an independent prognostic factor in resected lung adenocarcinoma: the role of resection type.World journal of surgical oncology · 2026Article
- CLDN18.2 expression identifies a gastric-type phenotype and a potential therapeutic target in pulmonary invasive mucinous adenocarcinoma.Diagnostic pathology · 2026Article
- Tumor Spread through Air Spaces in Early-Stage Lung Adenocarcinoma: Surgical Implications and Patient Management Strategies.Journal of chest surgery · 2026Review
- Predicting STAS in peripheral stage I lung adenocarcinoma: the incremental value of CT-based tumor disappearance rate, with a focus on part-solid nodules.BMC medical imaging · 2026Article
- Diffusion attention expert model for predicting and semi-automatic localizing STAS in lung cancer histopathological images.Nature communications · 2026Article
112 more citing papers are in PubMed but not listed here.
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Abstract
introductionSpread 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 (1) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (2) effect of surgical margin-to-tumor diameter ratio in STAS-positive patients, and (3) potential utility of frozen sections (FSs) for detecting STAS intraoperatively.
methodsWe investigated 1497 patients who underwent lobectomy (n = 970) or sublobar resection (n = 527) for T1N0M0 lung ADC after propensity score matching. Outcomes were analyzed by using a competing risks approach. The effect of margin-to-tumor ratio on recurrence pattern (locoregional and distant) was investigated in patients who underwent sublobar resection. Five pathologists evaluated the feasibility of intraoperatively identifying STAS by using FSs (sensitivity, specificity, and interrater reliability).
resultsOn multivariable analysis after 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-to-tumor ratio (for a margin-to-tumor ratio of ≥1 versus <1, the 5-year cumulative incidence of recurrence rates were 16% and 25%, respectively); among patients without STAS, locoregional recurrences occurred in patients with margin-to-tumor ratio lower than 1 (a 5-year cumulative incidence of recurrence rate of 7%). The sensitivity and specificity for detecting STAS by use of FSs were 71% and 92%, with substantial interrater reliability (Gwet's AC1, 0.67).
conclusionsIn patients with T1 lung ADC with STAS, lobectomy was associated with better outcomes than sublobar resection was. Pathologists can recognize STAS on FSs.
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