Spread Through Air Spaces (STAS) Is Prognostic in Atypical Carcinoid, Large Cell Neuroendocrine Carcinoma, and Small Cell Carcinoma of the Lung
Menée à partir de l'analyse d'échantillons tumoraux prélevés sur 487 patients atteints d'une tumeur pulmonaire neuroendocrine de stade I à III traité par résection entre 1992 et 2012, cette étude met en évidence une association entre la propagation tumorale aérienne de type STAS (Spread through air spaces) et le pronostic des patients atteints d'une tumeur carcinoïde atypique, d'un carcinome neuroendocrinien à grandes cellules ou d'un carcinome à petites cellules
Introduction : Tumor spread through air spaces (STAS) has prognostic significance in lung adenocarcinoma and squamous cell carcinoma. We sought to investigate the prognostic importance of STAS in lung neuroendocrine tumors (NETs).
Methods : All tumor slides from patients with resected pathologic stage I-III lung NETs (overall, n=487; typical carcinoid [TC], n=299; atypical carcinoid [AC], n=38; large cell neuroendocrine carcinoma [LCNEC], n=93; small cell lung carcinoma [SCLC], n=57) treated between 1992 and 2012 were evaluated for presence of STAS. Cumulative incidence of recurrence (CIR) and lung cancer–specific cumulative incidence of death (LC-CID) were analyzed using a competing-risks approach.
Results : STAS was identified in 26% of NETs (16% of TCs, 37% of ACs, 43% of LCNECs, and 46% of SCLCs). STAS was associated with distant metastasis as well as higher CIR and LC-CID in the overall cohort and the AC, LCNEC, and SCLC cohorts (owing to a small number of recurrences and deaths [<5], prognostic analysis was not performed in the TC cohort). In multivariable analysis stratified by stage, STAS was significantly associated with higher CIR (subhazard ratio [SHR], 2.85; 95% confidence interval [CI], 1.73-4.68 [p<0.001]) and LC-CID (SHR, 2.72; 95% CI, 1.57-4.70 [p<0.001]), independent of histologic subtype. STAS independently associated with CIR and LC-CID in the LCNEC cohort and LC-CID in the SCLC cohort.
Conclusions : In patients with lung NETs, STAS is associated with early, distant metastasis and worse LC-CID. In patients with LCNEC or SCLC, STAS is an independent poor prognostic factor.
Journal of Thoracic Oncology , résumé, 2018