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Yildirim S, Alan O, Yuksel Yasar Z, Kaya T, Akdag G, Kinikoglu O, Gecmen GG, Yasar A, Isik D, Surmeli H, Basoglu T, Sever ON, Yildirim ME, Odabas H, Turan N. Prognostic Impact and Clinical Features of Spread through Air Spaces in Operated Lung Cancer: Real-World Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1374. [PMID: 39202654 PMCID: PMC11356374 DOI: 10.3390/medicina60081374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/30/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Lung cancer is the leading cause of cancer-related deaths. Spread through air spaces (STAS) is an adverse prognostic factor that has become increasingly known in recent years. This study aims to investigate the impact of STAS presence on overall survival (OS) and disease-free survival (DFS) in patients with surgically resected stage IA-IIIA lung cancer and to identify clinicopathological features associated with STAS. Materials and Methods: This research involved 311 lung cancer surgery patients. The relationship between the presence of STAS in the patients' surgical pathology and OS and DFS values was examined. Clinicopathological features associated with the presence of STAS were determined. Results: There were 103 (33%) STAS-positive patients. Adenocarcinoma histological subtype, perineural invasion (PNI), and lymphovascular invasion (LVI) were significantly correlated with being STAS positive. STAS significantly predicted DFS and OS. One-year and five-year DFS rates were significantly lower in the STAS-positive group compared to the STAS-negative group (65% vs. 88%, 29% vs. 62%, respectively, p ≤ 0.001). Similarly, one-year and five-year OS rates were significantly lower in the STAS-positive group compared to the STAS-negative group (92% vs. 94%, 54% vs. 88%, respectively, p ≤ 0.001). In multivariate analysis, STAS was found to be an independent prognostic factor for both DFS and OS (HR: 3.2 (95%CI: 2.1-4.8) and 3.1 (95%CI: 1.7-5.5), p < 0.001 and <0.001, respectively). Conclusions: In our study, STAS was found to be an independent prognostic biomarker in operated stage IA-IIIA lung cancer patients. It may be a beneficial pathological biomarker in predicting the survival of patients and managing their treatments.
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Affiliation(s)
- Sedat Yildirim
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Ozkan Alan
- Division of Medical Oncology, School of Medicine, Koc University, Istanbul 34450, Turkey;
| | - Zeynep Yuksel Yasar
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Tugba Kaya
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Goncagul Akdag
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Oguzcan Kinikoglu
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Gonca Gul Gecmen
- Department of Pathology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey;
| | - Alper Yasar
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Deniz Isik
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Heves Surmeli
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Tugba Basoglu
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Ozlem Nuray Sever
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Mahmut Emre Yildirim
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Hatice Odabas
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
| | - Nedim Turan
- Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul 34865, Turkey; (Z.Y.Y.); (T.K.); (G.A.); (O.K.); (A.Y.); (D.I.); (H.S.); (T.B.); (O.N.S.); (M.E.Y.); (H.O.); (N.T.)
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Travis WD, Eisele M, Nishimura KK, Aly RG, Bertoglio P, Chou TY, Detterbeck FC, Donnington J, Fang W, Joubert P, Kernstine K, Kim YT, Lievens Y, Liu H, Lyons G, Mino-Kenudson M, Nicholson AG, Papotti M, Rami-Porta R, Rusch V, Sakai S, Ugalde P, Van Schil P, Yang CFJ, Cilento VJ, Yotsukura M, Asamura H. The International Association for the Study of Lung Cancer (IASLC) Staging Project for Lung Cancer: Recommendation to Introduce Spread Through Air Spaces as a Histologic Descriptor in the Ninth Edition of the TNM Classification of Lung Cancer. Analysis of 4061 Pathologic Stage I NSCLC. J Thorac Oncol 2024; 19:1028-1051. [PMID: 38508515 DOI: 10.1016/j.jtho.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Spread through air spaces (STAS) consists of lung cancer tumor cells that are identified beyond the edge of the main tumor in the surrounding alveolar parenchyma. It has been reported by meta-analyses to be an independent prognostic factor in the major histologic types of lung cancer, but its role in lung cancer staging is not established. METHODS To assess the clinical importance of STAS in lung cancer staging, we evaluated 4061 surgically resected pathologic stage I R0 NSCLC collected from around the world in the International Association for the Study of Lung Cancer database. We focused on whether STAS could be a useful additional histologic descriptor to supplement the existing ones of visceral pleural invasion (VPI) and lymphovascular invasion (LVI). RESULTS STAS was found in 930 of 4061 of the pathologic stage I NSCLC (22.9%). Patients with tumors exhibiting STAS had a significantly worse recurrence-free and overall survival in both univariate and multivariable analyses involving cohorts consisting of all NSCLC, specific histologic types (adenocarcinoma and other NSCLC), and extent of resection (lobar and sublobar). Interestingly, STAS was independent of VPI in all of these analyses. CONCLUSIONS These data support our recommendation to include STAS as a histologic descriptor for the Ninth Edition of the TNM Classification of Lung Cancer. Hopefully, gathering these data in the coming years will facilitate a thorough analysis to better understand the relative impact of STAS, LVI, and VPI on lung cancer staging for the Tenth Edition TNM Stage Classification.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Megan Eisele
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | | | - Rania G Aly
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pietro Bertoglio
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei, Veterans General Hospital, Taipei, Taiwan
| | | | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People's Republic of China
| | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec - Université Laval, Quebec City, Canada
| | - Kemp Kernstine
- Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yolande Lievens
- Radiation Oncology, Ghent University Hospital and Ghent University, Gent, Belgium
| | - Hui Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangdong, People's Republic of China
| | - Gustavo Lyons
- Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton Hospital, London, United Kingdom
| | - Mauro Papotti
- Department of Oncology, University of Turin, Torino, Italy
| | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Valerie Rusch
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shuji Sakai
- Tokyo Women's Medical University, Tokyo, Japan
| | - Paula Ugalde
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Paul Van Schil
- Antwerp University and Antwerp University Hospital, (Edegem) Antwerp, Belgium
| | - Chi-Fu Jeffrey Yang
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Department of Thoracic Surgery, Keio University, Tokyo, Japan
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Li Y, Adusumilli PS, Chou TY, Kadota K, Mino-Kenudson M, Papotti M, Rekhtman N, Yagi Y, Yatabe Y, Travis WD. Pro: "Is Spread Through Air Spaces an In Vivo Phenomenon or an Inducible Artifact?". J Thorac Oncol 2024; 19:677-697. [PMID: 38719424 DOI: 10.1016/j.jtho.2024.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2025]
Abstract
In this PRO-CON debate, you will read very different perspectives about a simple question regarding an observation under the microscope: What is the significance of tumor cells in the air spaces of the lung parenchyma beyond the tumor edge of a resected lung cancer? An important underlying question is whether this entire PRO-CON debate is a mere academic exercise or whether spread through air spaces (STAS), as currently defined, describes a clinically useful phenomenon. The journey of STAS began with a complete paradigm shift to reverse the thinking that all air space tumor cells beyond the edge of lung cancers are an artifact. This led to a new concept where STAS could be separated from artifacts with a definition that has proven to be clinically useful. As with any major change in thinking, it is understandable that there would be some disagreement with this paradigm shift. Nevertheless, after a decade since it was described, many pathologists and clinicians around the world have found STAS to provide important information about the behavior of lung cancer. Numerous PRO-STAS articles supporting the usefulness of STAS have been published with clinical data on many thousands of patients from numerous institutions all over the world. In contrast, for the CON-STAS articles, widespread international representation and data are limited. It is now difficult to ignore the numerous reports and is reasonable to consider how to use the presence of STAS in clinical decisions. Hopefully, this PRO-CON debate will further stimulate clinical and scientific investigations aimed at a better understanding of STAS.
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Affiliation(s)
- Yan Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, People's Republic of China
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Teh-Ying Chou
- Department of Pathology and Precision Medicine Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kyuichi Kadota
- Molecular Oncologic Pathology, Department of Pathology and Host Defense, Kagawa University, Kagawa, Japan
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Natasha Rekhtman
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yukako Yagi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yasushi Yatabe
- Department of Pathology, National Cancer Center, Tokyo, Japan
| | - William D Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Pyo JS, Lee BH, Min KW, Kim NY. Clinicopathological significances of cribriform pattern in lung adenocarcinoma. Pathol Res Pract 2024; 253:155035. [PMID: 38171080 DOI: 10.1016/j.prp.2023.155035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
The present study aimed to investigate the clinicopathological and prognostic implications of the cribriform pattern in lung adenocarcinoma through a meta-analysis. The estimated rates of cribriform pattern in lung adenocarcinomas were investigated. The correlations between cribriform pattern and clinicopathological characteristics, including genetic alterations and prognosis were evaluated. The estimated rate of cribriform pattern was 0.150 (95% confidence interval [CI], 0.101-0.218) in lung adenocarcinoma. The estimated rates of cribriform pattern in the 5% and 10% criteria were 0.230 (95% CI 0.125-0.386) and 0.130 (95% CI 0.062-0.252), respectively. The presence of cribriform pattern was significantly correlated with larger tumor size (> 30 mm), spread through air spaces, and lymph node metastasis (P < 0.001, P < 0.001, and P = 0.007, respectively, in the meta-regression test). There were no significant differences between cribriform pattern, smoking history, and vascular and lymphatic invasion. In lung adenocarcinoma with cribriform pattern, the estimated rates of ALK rearrangement, KRAS, and EGFR mutations were 0.407 (95% CI 0.165-0.704), 0.330 (95% CI 0.117-0.646), and 0.249 (95% CI 0.125-0.437), respectively. ALK rearrangement was significantly more frequent in lung adenocarcinomas with cribriform pattern than in those without. The overall survival rate was significantly worse in lung adenocarcinomas with a cribriform pattern than in those without (hazard ratio 2.051, 95% CI 1.369-3.075). In conclusion, the presence of a cribriform pattern can be a useful predictor of the clinicopathological characteristics and prognosis of patients with lung adenocarcinoma.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Byoung-Hoon Lee
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Kyueng-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Nae Yu Kim
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea.
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Wang J, Yao Y, Tang D, Gao W. An individualized nomogram for predicting and validating spread through air space (STAS) in surgically resected lung adenocarcinoma: a single center retrospective analysis. J Cardiothorac Surg 2023; 18:337. [PMID: 37990253 PMCID: PMC10664312 DOI: 10.1186/s13019-023-02458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE A single-center study was conducted to explore the association between STAS and other clinical features in surgically resected adenocarcinoma to enhance our current understanding of STAS. METHODS We retrospectively enrolled patients with lung adenocarcinoma (n = 241) who underwent curative surgeries. Patients undergoing surgery in 2019 were attributed to the training group (n = 188) and those undergoing surgery in January 2022 to June 2022 were attributed to the validation (n = 53) group. Univariate and multivariate logistic regression analyses were used to identify predictive factors for STAS, which were used to construct a simple nomogram. Furthermore, ROC and calibration curves were used to evaluate the performance of the nomogram. In addition, we conducted decision curve analysis (DCA) to assess the clinical utility of this nomogram. RESULTS In our cohort, 52 patients were identified as STAS-positive (21.6%). In univariate analysis, STAS was significantly associated with age, surgical approach, CEA, CTR (Consolidation Tumor Ratio), TNM stage, tumor grade, gross tumor size, resection margin, vessel cancer embolus, pleural invasion, lymph node metastasis, high ki67 and positive PD-L1 staining (P < 0.05). Lower age, CTR > 0.75, vessel cancer embolus, high Ki67 and PD-L1 stain positive were significant predictors for STAS during multivariate logistics analysis. A simple nomogram was successfully constructed based on these five predictors. The AUC values of our nomogram for the probability of tumor STAS were 0.860 in the training group and 0.919 in the validation group. In addition, the calibration curve and DCA validated the good performance of this model. CONCLUSION A nomogram was successfully constructed to identify the presence of STAS in surgically resected lung adenocarcinoma patients.
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Affiliation(s)
- Jing Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China
| | - Yuanshan Yao
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China
| | - Dongfang Tang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China
| | - Wen Gao
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China.
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Ye R, Yu Y, Zhao R, Han Y, Lu S. Comprehensive molecular characterizations of stage I-III lung adenocarcinoma with tumor spread through air spaces. Front Genet 2023; 14:1101443. [PMID: 36816028 PMCID: PMC9932204 DOI: 10.3389/fgene.2023.1101443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose: The aim of this study is to investigate integrative genomic spectra of stage I-III lung adenocarcinoma with tumor spread through air spaces (STAS). Methods: We retrospectively identified 442 surgically resected lung adenocarcinoma patients of pathological stage I-III in Shanghai Chest Hospital from January 2018 to February 2021. Surgically resected tissues were used for next-generation sequencing (NGS) with a panel of 68 lung cancer-related genes to profile comprehensive molecular characterizations. Results: A total of 442 cases were analyzed, including 221 (50%) STAS-positive (SP) and 221 (50%) STAS-negative (SN) lung adenocarcinoma patients. In total, 440 cases (99.6%) were positive for the overall mutational spectrum, and the higher mutational genes were EGFR, TP53, KRAS, ALK, SMAD4, and ERBB2 (62%, 42%, 14%, 10%, 7%, and 7%, respectively). Compared with the SN population, there was significantly lower EGFR alteration in the single-nucleotide variant (SNV) mutation spectrum (52.5% vs 69.7%, p < 0.001) and significantly higher TP53 alteration in the SP population (49.8% vs 34.8%, p = 0.002). EGFR L858R missense mutation (19.5% vs 37.6%, p < 0.001) and ERBB2 exon 20 indel mutation (1.8% vs 5.9%, p = 0.045) were more frequent in the SN population. The detection rate of ALK fusion rearrangements in the SP population was significantly higher than that in the SN population (13.1% vs 2.3%, p < 0.001). In the analysis of signaling pathways, no significant difference was discovered between SP and SN patients. No difference in 1-year disease-free survival was observed between SP and SN patients in this study. Conclusion: Significant differences exist in stage I-III lung adenocarcinoma patients with STAS in molecular characterizations.
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Affiliation(s)
- Ronghao Ye
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yongfeng Yu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruiying Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Shun Lu,
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