通过空气间隙扩散被定义为肺癌中远离肿瘤边缘的空气间隙中的肿瘤细胞。在肺腺癌中，这与更高的局部复发率和更低的生存率有关。通过空气间隙扩散的不良结果特征仍在调查中。我们回顾了肺癌经验以定义可能影响复发和生存的与通过空气间隙扩散相关的潜在因素。在2010年1月至2017年12月期间，我们确定了968例行T1-3N0M0肺腺癌切除术的患者。其中，787名患者的组织学检查是可能的。我们检查了通过空气间隙扩散的存在，通过空气间隙扩散的特征（微乳头状、实性巢状或单个细胞）、平均密度（每张幻灯片的数量）以及通过空气间隙到达最远的肿瘤距离或最大扩散距离。使用Kaplan-Meier曲线估计总生存率和无复发生存率，并使用log-rank检验评估通过空气间隙扩散阳性组与通过空气间隙扩散阴性组之间的差异。在被回顾的病例中，787例中有389例（49.4%）存在通过空气间隙扩散。通过空气间隙扩散的阳性组10年的总生存率和无复发生存率显著低于阴性组（P <0.0001）。在通过空气间隙扩散阳性组，局部和远处复发的发病率在10年内几乎翻了一倍，与通过空气间隙扩散阴性组相比（P = 0.002和<0.0001）。在多变量Cox回归模型中，经调整通过空气间隙扩散的特征、距离和肿瘤大小，叶叶切除在通过空气间隙扩散患者中并不具有生存优势（次叶叶切除相对于叶叶切除的风险比是1.44，95%置信区间为0.98-2.11；P = 0.067）。在通过空气间隙扩散阳性组中，通过空气间隙扩散密度为2.7±1.4个集群/幻灯片，最大扩散距离为2.2±1.7mm，与总生存率或复发之间没有观察到相关性。我们展示了通过空气间隙扩散阳性的肺腺癌的远处复发增加。通过空气间隙扩散的可量化措施似乎与复发或生存指标不相关。 版权所有©2023年美国胸外科协会。由Elsevier Inc.发表。保留所有权利。

Spread through air spaces is defined as tumor cells in air spaces away from the edge of tumor in lung carcinoma. It is associated with higher locoregional recurrence and lower survival in lung adenocarcinoma. The features of spread through air spaces portending worse outcomes are still under investigation. We reviewed our lung cancer experience to define potential factors related to spread through air spaces that influence recurrence and survival.Between January 2010 and December 2017, we identified 968 patients who underwent resection for T1-3N0M0 lung adenocarcinoma. Of these, histologic examination was possible in 787 patients. We examined the presence of spread through air spaces, spread through air spaces characteristics (micropapillary, solid nest, or single cell), average density (number per slide), and farthest distance from tumor at which spread through air spaces was detected, or maximal spread distance. Overall survival and recurrence-free survival were estimated using Kaplan-Meier curves, and differences between spread through air spaces positive versus spread through air spaces negative groups were assessed using the log-rank test.Spread through air spaces was present in 389 of 787 of the reviewed cases (49.4%). Overall survival and recurrence-free survival were significantly lower in the spread through air spaces positive group over 10 years (P < .0001). The incidences of locoregional and distant recurrence were nearly doubled over 10 years in the spread through air spaces positive group compared with the spread through air spaces negative group (P = .002 and <.0001, respectively). In a multivariable Cox regression model adjusted for spread through air spaces characteristics, distance, and tumor size, lobar resection did not confer survival advantage in patients with spread through air spaces (hazard ratio of sublobar resection with respect to lobar resection, 1.44; 95% confidence interval, 0.98-2.11; P = .067). In the spread through air spaces positive group, spread through air spaces density was 2.7 ± 1.4 clusters per slide and the maximal spread distance was 2.2 ± 1.7 mm from the tumor edge. There was no observed correlation between spread through air spaces density or maximal spread distance and overall survival or recurrence.We show increased distant recurrence in spread through air spaces positive lung adenocarcinoma. Quantifiable measures of spread through air spaces do not appear to correlate with recurrence or survival metrics.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.