ArticlePathology international2026
Clinicopathological Significance of Extra-Alveolar Invasion in Lung Adenocarcinomas Treated With Sublobar Resection.
Article in Pathology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Lung adenocarcinoma exhibits diverse pathological features, some of which for example, histological grading and tumor spread through air spaces (STAS), can be used for prognosis. Extra-alveolar invasion (EX) is a unique pathological factor focused on depth of invasion, and is defined as tumor infiltration into periarterial, peribronchiolar, or interlobular septal stroma. We recently suggested EX as a prognostic indicator, but its significance in sublobar resection remains unclear. We investigated the prognostic impact of EX in 116 patients with pT1mi-pT2a non-mucinous lung adenocarcinoma treated by segmentectomy or wedge resection. EX was evaluated using elastic fiber staining. Among 10 recurrent cases, 8 were EX-positive, and 2 were EX-negative and STAS-positive. The EX(-)/STAS(+) cases had local recurrence, while the EX(+) cases exhibited metastatic recurrence. The pT1abc EX(+) group showed significantly shorter recurrence-free survival (RFS) than the pT1abc EX(-) group, but no significant differences were observed when compared with the pT2 group. EX(+ )/STAS(-) and EX(+ )/STAS(+) groups showed significantly shorter RFS than EX(-)/STAS(-) group, but EX(-)/STAS(+) group did not. In conclusion, EX was associated with poor prognosis after sublobar resection of lung adenocarcinoma. Combined evaluation of EX and STAS may improve postoperative risk stratification.
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