文章：

肺癌中空气传播途径的多学科视角：一篇叙述性综述

Multidisciplinary Perspective of Spread Through Air Spaces in Lung Cancer: A Narrative Review

原文发布日期：19 October 2025

DOI: 10.3390/cancers17203374

类型: Article

开放获取: 是

英文摘要：

Spread Through Air Spaces (STAS) is an emerging pattern of tumor invasion in lung cancer, first recognized by the World Health Organization in 2015. This narrative review examines STAS from a multidisciplinary perspective, integrating pathologic, radiologic, oncologic, and surgical points of view, together with molecular biology to assess its clinical significance, diagnostic challenges, and therapeutic implications. Pathologically, STAS is characterized by tumor cells floating beyond the main tumor, contributing to recurrence and poor prognosis. Radiologic advancements suggest potential imaging markers for STAS, such as spiculation, the absence of an air bronchogram, solid tumor components, as well as high fluorodeoxyglucose uptake, though definitive preoperative identification remains challenging. Oncologic studies link STAS to aggressive tumor behavior and lympho-vascular invasion, suggesting a role for adjuvant chemotherapy even in the earliest stages of disease; furthermore, specific molecular alterations have been discovered, including EGFR wild-type status and ALK/ROS1 rearrangements together with high Ki-67 expression, tumor necrosis, and alterations in cell adhesion proteins like E-cadherin. Surgical aspects highlight the increased risk of recurrence following limited resection, raising concerns about optimal surgical strategies. The debate over STAS as a true invasion mechanism versus an artifact from surgical handling underscores the need for standardized pathological evaluation. This review aims to refine STAS detection, integrate it into multidisciplinary treatment decision-making, and assess its potential as a staging criterion in lung cancer management.

摘要翻译： 

气腔播散（STAS）是肺癌中一种新兴的肿瘤侵袭模式，于2015年首次被世界卫生组织确认。本文通过多学科视角对STAS进行系统性评述，整合病理学、影像学、肿瘤学及外科学观点，并结合分子生物学研究，评估其临床意义、诊断挑战与治疗启示。病理学上，STAS的特征是肿瘤细胞脱离主病灶在气腔内播散，这与肿瘤复发及不良预后密切相关。影像学进展提示了潜在的STAS影像标志物，如毛刺征、空气支气管征缺失、实体瘤成分以及高氟代脱氧葡萄糖摄取，但术前明确诊断仍具挑战。肿瘤学研究将STAS与侵袭性肿瘤行为及淋巴血管侵犯相关联，提示即使在疾病最早期阶段也可能需要辅助化疗；此外，研究发现了特定的分子改变，包括EGFR野生型状态、ALK/ROS1重排、高Ki-67表达、肿瘤坏死以及E-钙黏蛋白等细胞黏附蛋白的改变。外科学角度强调局限性切除术后复发风险增高，引发了对最佳手术策略的思考。关于STAS是真实侵袭机制还是手术操作所致人工假象的争论，凸显了标准化病理评估的必要性。本综述旨在完善STAS检测手段，将其纳入多学科治疗决策体系，并评估其作为肺癌分期标准的潜在价值。

原文链接：

Multidisciplinary Perspective of Spread Through Air Spaces in Lung Cancer: A Narrative Review