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Overall Survival Analysis Of Surgery And Adjuvant Chemotherapy In Patients With Tumor Spread Through Air Spaces
Yilv Lv, Kuan Xu, Bo Ye.
Shanghai chest hospital, Shanghai, China.

BACKGROUND:The survival benefit of different surgical strategies and adjuvant chemotherapy (ACT) for patients with non-small cell lung cancer (NSCLC) with spread through air spaces (STAS) remains unclear. This study aims to investigate the prognostic effects of surgical strategies and adjuvant chemotherapy on patients with NSCLC/STAS-positive and other prognostic factors on patients with stage II and III NSCLC/STAS-positive.
METHODS:The clinicopathological data of 3150 patients with non-small cell lung cancer who underwent surgical resection in our hospital from January 2014 to December 2018 were retrospectively collected, of which 1023 cases were diagnosed with STAS-positive. The Kaplan-Meier analysis and Cox proportional hazard regression model were used to explore the impact of STAS on the prognosis of patients and determine the treatment methods suitable for patients of different stages.
RESULTS:Patients with NSCLC/STAS-positive had lower overall survival (OS) and recurrence-free survival(RFS) than patients with NSCLC/STAS-negative (P<0.05). The Kaplan-Meier analysis revealed that under the same risk factor stratification, there was no significant difference in OS and RFS between the ACT and control group of stage IA patients. ACT improves the prognosis of patients with stage IB NSCLC/STAS-positive and high-risk factors. No significant difference between Sublobar resection and lobectomy group for stage I patients. For patients with stage II and III NSCLC/STAS-positive, DFS of the Targeted and adjuvant chemotherapy group was lower than that of the ACT group, but the overall survival rate was not significantly different from that of the ACT group.
CONCLUSIONS:The presence of STAS was associated with poor prognosis in patients with NSCLC. We recommend patients with stage IB NSCLC/STAS-positive with high-risk factors receive ACT and patients with stage II and III NSCLC/STAS-positive receive targeted and adjuvant chemotherapy.
LEGEND: (A) OS and (B) RFS of patients with STAS-positive and STAS-negetive.(C) OS and (D) RFS of stage IA patients with STAS-positive stratified by chemotherapy and risk factors.

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