Studies On The Clinicopathological Features Of Lung Adenocarcinoma Patients With STAS

Objective: To explore the relationship between “Spread through Air Space” and the clinicopathological characteristics and its influence on the prognosis of patients with lung adenocarcinoma.Methods: We collected 225 patients who were postoperatively diagnosed of invasive adenocarcinoma in the first affiliated hospital of Anhui Medical University from January 2013 to December 2014.Then we observed HE section under light microscope.Tumor size,necrosis,pleural invasion,lymph node metastasis and the STAS situation were recorded.We reviewed the patients' archives and record its age,gender,surgical methods and smoking status.Survival data of 132 patients were obtained through outpatient and telephone follow-up,including 81 patients with stage I lung adenocarcinoma.SPSS 22.0 software was used to analyze this data.Chi-square test was used to analyze qualitative data.Kaplan Meier and Cox regression test were used to analyze DFS and OS.Log-rank test was used to analyze the difference between two groups.Results:1.There were 118 STAS positive cases(positive ratio is 52.4%).STAS positive ratio was higher in cases like greater than 3cm or necrosis or lymph node metastasis or pleural invasion,61.1%,70.1%,84.2% and 62.7% respectively,P < 0.05.The STAS positive people account for 12.1% of the lepidic predominant adenocarcinoma patients,40.5% of acinar predominant adenocarcinoma patients,77.1% of papillary predominant adenocarcinoma patients,78.0% ofmicropapillary predominant adenocarcinoma and 85.7% of solid predominant adenocarcinoma patients.Chi-square test show that the difference was statistically significant,P = 0.000.STAS was associated with clinical staging.In patients with stage I-IV adenocarcinoma that STAS positive ratio is 35.5%,70.4%,82.5% and 70.4% respectively,P <0.05.2.We analyzed the survival data of 132 patients,single factor analysis showed that the STAS was associated with survival time,P < 0.05.Tumor size,necrosis,pleura invasion,histological type and clinical stage were associated with prognosis,P < 0.05.Cox regression analysis showed that STAS was an independent risk factor for DFS and OS in patients with lung adenocarcinoma,P < 0.05.Necrosis was associated with DFS,P = 0.015.Lymph node metastasis was an important factors affecting OS,P = 0.025.3.The follow-up data of 81 patients with stage I lung adenocarcinoma were analyzed by K-M method.The Log-rank test result shows that the presence of necrosis and STAS were associated with DFS,P < 0.05.Cox regression analysis showed that tumor necrosis is associated with DFS,P = 0.019).The STAS and tumor necrosis were independent risk factors for OS in patients with stage I lung adenocarcinoma.Conclusions1.STAS was associated with tumor size,necrosis,lymph node metastasis,pleural invasion,histological type and clinical staging.2.The tumor stage,lymph node metastasis,pleural invasion and STAS were important factors affecting DFS and OS of patient.3.STAS was closely related to the clinicopathological characteristics and prognosis of tumor.Artificial phenomenon can't explain this.It may become a new kind of morphological prognostic index.Clinical and pathological physicians should pay more attention on it.