The Presence of Both Tumor Spread through Air Spaces and Visceral Pleural Invasion May Increase Tumor Recurrence Risk in Non-Small Cell Lung Cancer

TL;DR

Having both tumor spread through air spaces and visceral pleural invasion in lung cancer may increase the risk of tumor recurrence, though it doesn't affect overall survival.

Contribution

This study identifies a compounding effect of STAS and VPI on recurrence risk in non-small cell lung cancer.

Findings

34 patients (8%) had both STAS and VPI, which correlated with increased smoking, larger tumors, and lymphovascular invasion.

Combined STAS and VPI were linked to a significantly higher recurrence risk (p = 0.001), but not to reduced overall survival (p = 0.190).

Abstract

Tumor spread through air spaces (STAS) and visceral pleural invasion (VPI) are negative prognostic factors in lung cancer. However, it is unknown whether they have a compounding prognostic effect. Therefore, we analyzed the association between STAS and VPI with overall survival and recurrence.

A retrospective cohort analysis was conducted on 421 adult patients who underwent pulmonary resection for non-small cell lung cancer at an academic institution between 2018 and 2022. Baseline characteristics were compared between patients who had STAS only, VPI only, or both STAS and VPI. Overall survival and cumulative recurrence were compared using the Kaplan–Meier method.

Of the 421 patients who underwent a pulmonary resection, 34 (8%) had both STAS and VPI. Their combined presence was associated with increased smoking pack-years, increased tumor size, and an increased presence of lymphovascular invasion. There was no overall survival difference (p = 0.190) between patients with both STAS and VPI and those with only one feature or neither. However, cumulative incidence of recurrence was increased (p = 0.001) for patients with both.

The presence of STAS and VPI was not associated with decreased overall survival; however, their combined presence may have a compounding effect on recurrence risk.

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