ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2025
Concurrent spread through air spaces in dominant tumours impacts prognosis in synchronous multiple primary lung adenocarcinoma.
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Paired Inter-Lesion Invasiveness and Recurrence Risk in Synchronous Multiple Primary Lung Adenocarcinoma: Focus on the IAC-Dominant Subgroup.Journal of clinical medicine · 2026Article
- Spread Through Air Spaces in Multiple Synchronous Bilateral Primary Lung Cancer: Prognostic Implications in a Surgical Cohort.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
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Abstract
objectivesThe impact of tumour spread through air spaces (STAS) on the prognosis of synchronous multiple primary lung adenocarcinoma (sMPLA) remains unclear. This study evaluates the prognostic significance of STAS in early-stage sMPLA and its combined effect with surgical strategies.
methodsPatients with cT1-3N0M0 sMPLA (2012-2018) were selected based on multidisciplinary team evaluation, surgical confirmation of invasive adenocarcinoma and exclusion of metastases or minimally invasive disease. Prognostic variables were selected using the least absolute shrinkage and selection operator regression with grouped variables. Survival outcomes were analysed via Cox proportional-hazards models for overall survival and Fine & Gray competing risk regression for recurrence-free survival.
resultsAmong 131 patients, STAS was observed in 68 (51.9%), including 21 (16.0%) with STAS in both tumours (bi-STAS) and 47 (35.9%) with STAS in one tumour. Bi-STAS independently predicted worse overall survival (hazard ratio = 3.78, 95% confidence interval: 1.23-11.65, P = 0.020) and recurrence-free survival (hazard ratio = 3.99, 95% confidence interval: 1.34-11.93, P = 0.013). Patients with bi-STAS had significantly lower overall survival (P < 0.001) and higher cumulative incidence of recurrence (P < 0.001) compared to mono-STAS/un-STAS groups. Notably, bi-STAS patients showed similar survival outcomes whether undergoing lobectomy or sublobar resection (overall survival: P = 0.889; recurrence-free survival: P = 0.857), underscoring limited benefit from extensive surgery.
conclusionsConcurrent bi-STAS is a strong prognostic marker for early-stage sMPLA, independent of surgical strategy. Comprehensive STAS evaluation in all dominant tumours is critical for postoperative risk stratification.
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