This study aimed to identify the clinical manifestation and implications according to the grading of tumor spread through air spaces in early-stage small (≤2 cm) pathological stage I non-mucinous lung adenocarcinomas. Medical records of patients with pathological stage I tumors sized ≤2 cm were retrospectively reviewed and analyzed. The furthest distance of the spread through air spaces from the tumor margin was measured on a standard-length scale (mm). Enrolled patients were categorized into spread through air spaces (STAS) (−) and STAS (+), and STAS (+) was subdivided according to its furthest distance as follows: STAS (+)-L (<2 mm) and STAS (+)-H (≥2 mm). Risk factors for STAS (+) included papillary predominant subtype (p= 0.027), presence of micropapillary patterns (p< 0.001), and EGFR (p= 0.039). The overall survival of the three groups did not differ significantly (p= 0.565). The recurrence-free survival of STAS (+)-H groups was significantly lower than those of STAS (−) and STAS (+)-L (p< 0.001 andp= 0.039, respectively). A number of alveolar spaces were definite risk factors for STAS (+)-H groups (p< 0.001), and male gender could be one (p= 0.054). In the patient group with small (≤2 cm) pathological stage I lung adenocarcinomas, the presence of STAS ≥ 2 mm was related to significantly lower recurrence-free survival. For identifying definite risk factors for the presence of farther STAS, more precise analysis from a larger study population should be undertaken.
本研究旨在探讨早期（≤2厘米）病理I期非黏液性肺腺癌中，肿瘤气腔播散分级与临床表现及预后的关联。研究回顾性分析并评估了病理I期且肿瘤直径≤2厘米患者的医疗记录。采用标准长度尺度（毫米）测量了肿瘤边缘至气腔播散的最远距离。将入组患者分为气腔播散（STAS）阴性组和STAS阳性组，并根据最远距离将STAS阳性组进一步细分为：STAS阳性-低度组（<2毫米）和STAS阳性-高度组（≥2毫米）。STAS阳性的风险因素包括乳头状为主亚型（p=0.027）、微乳头状结构的存在（p<0.001）以及EGFR突变（p=0.039）。三组患者的总生存期无显著差异（p=0.565）。STAS阳性-高度组的无复发生存期显著低于STAS阴性组和STAS阳性-低度组（分别为p<0.001和p=0.039）。多个肺泡空间是STAS阳性-高度组的明确风险因素（p<0.001），而男性可能也是一个风险因素（p=0.054）。在病理I期小（≤2厘米）肺腺癌患者中，STAS≥2毫米的存在与显著降低的无复发生存期相关。为明确更远距离STAS存在的确切风险因素，需基于更大规模研究人群进行更精确的分析。
肿瘤(癌症)患者之家