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S. Lu
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MA12 - Miscellaneous Biology/Pathology (ID 476)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Biology/Pathology
- Presentations: 3
- Moderators:B. Dome, W.D. Travis
- Coordinates: 12/06/2016, 14:20 - 15:50, Schubert 1
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MA12.06 - Tumor Spread through Air Spaces (STAS) in Lung Squamous Cell Cancer is an Independent Risk Factor: A Competing Risk Analysis (ID 6051)
14:20 - 15:50 | Author(s): S. Lu
- Abstract
- Presentation
Background:
Tumor spread through air spaces (STAS) is a recently recognized pattern of invasion in lung adenocarcinoma, however, the incidence of and prognostic importance of STAS have not yet been defined in squamous cell carcinoma (SCC).
Methods:
In a cohort of 445 patients with p-stage I-III lung SCC, cumulative incidence of recurrence and lung cancer-specific death (LCSD) was evaluated by competing risks analysis and overall survival (OS) by Cox models.
Results:
76% of patients were >65 years of age. 273 patients died during follow up, one third (91, 33.3%) died of lung cancer whereas two thirds died of competing events or unknown cause. STAS was present in 132 (30%). The cumulative incidence of any, distant, and locoregional recurrence as well as LCSD were significantly higher in patients with STAS compared to those without STAS (Figure), whereas there was no statistically significant difference in OS. STAS was an independent predictor for both recurrence and LCSD in multivariable analysis (p=0.034 and 0.016, respectively, Table).
Conclusion:
STAS was present in one third of resected lung SCC and it was an independent predictor of recurrence and LCSD, supporting our proposal that STAS is a clinically important pattern of invasion and not an artifact. Figure 1 Figure 2
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MA12.08 - Clinicopathological Significance of Increasing Percentage of High-Grade Histological Subtypes in Lung Adenocarcinomas (ID 6023)
14:20 - 15:50 | Author(s): S. Lu
- Abstract
- Presentation
Background:
In early-stage lung adenocarcinomas, high-grade micropapillary (MIP) and solid (SOL) predominant pathology is known to be associated with worse prognosis. The aim of this study is, in addition to predominant patterns, to investigate clinical impact of the presence of small amounts (≥5%) as well as increasing percentage of high-grade patterns.
Methods:
Invasive tumors from early-stage lung adenocarcinoma patients who underwent curative-intent resection with no induction therapy were investigated (N=2017; 1995-2012) (8[th] edition TNM pStage I=1390, II=357, III=270). In 388 cases, synchronous lymph node (LN) metastases were available. Histological subtype (lepidic [LEP], acinar [ACI], papillary [PAP], MIP, or SOL) percentages were stratified into 4 groups; 0-4%, 5-24%, 25-49%, and 50-100%. The association between increasing percentage of patterns of primary tumor and the incidence of lymphatic/vascular invasion, necrosis, tumor spread through air spaces (STAS) as well as estimated 5-year cumulative incidence of recurrence (CIR) were analyzed. The differences in distribution of each pathological variable between 4 groups was analyzed by Chi-square test. The percentages of histological pattern were compared between primary tumor and LN metastasis.
Results:
Increasing percentage of MIP pattern is associated with increasing incidence of lymphatic/vascular invasion, STAS, as well as 5-year CIR (Figure 1a, p<0.001). Increasing percentage of SOL pattern is associated with increasing incidence of necrosis and 5-year CIR (p<0.001). Presence (≥5%) of SOL pattern is associated with higher incidence of lymphatic/vascular invasion and STAS (p<0.001) compared to the absence (<5%) of SOL pattern, but no significant relationship between lymphatic/vascular invasion and proportion of SOL pattern. The percentage of SOL pattern in LN metastasis is higher than that in synchronous primary tumors (Figure 1b).
Conclusion:
In early-stage lung adenocarcinomas, presence (≥5%) of MIP or SOL patterns as well as increasing percentages is associated with poor prognostic clinicopathological variables and incidence of recurrence. Figure 1
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MA12.09 - Comparative Histological Subtype Analysis of Lung Adenocarcinoma Tumor and Metastatic Lymph Nodes and the Prognostic Impact (ID 6036)
14:20 - 15:50 | Author(s): S. Lu
- Abstract
- Presentation
Background:
The goal of this study is to investigate comprehensive comparative pathological analyses of both primary tumor and metastatic lymph node (LN) and correlate with lung cancer-specific death (LC-death) in patients with LN-positive lung adenocarcinoma.
Methods:
PN1/2 lung adenocarcinoma patients who underwent R0 resection without induction therapy (n=402, 2000-2012) were included in the study. In primary tumor, lymphatic/vascular/pleural invasion, necrosis, tumor spread through air spaces (STAS), as well as histologic subtypes according to 2015 WHO classification were evaluated. In metastatic LN, metastatic tumor size, extracapsular invasion, histologic subtypes were evaluated. Recurrence and LC-death were analyzed by Cox model.
Results:
Micropapillary and solid predominant subtypes were more frequent in LN metastases than in primary tumors (Figure). In multivariable analyses, adjuvant chemotherapy, pleural invasion, extracapsular invasion of LN metastasis, micropapillary predominant subtype in LN metastasis were independent factors for recurrence; adjuvant chemotherapy, pleural invasion, tumor STAS, and extracapsular invasion were for LC-death (Table).
Conclusion:
In lung adenocarcinoma lymph node metastases, predominant micropapillary pattern and extracapsular invasion indicate high risk for recurrence and lung cancer-specific death. Figure 1 Figure 2
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-029 - Cases Demonstrating Spread Through Air Spaces (STAS) Reflects Invasive Growth and Not an Artifact (ID 6059)
14:30 - 15:45 | Author(s): S. Lu
- Abstract
Background:
STAS is defined as a pattern of tumor cell spread in the lung parenchyma beyond the edge of a lung cancer. It has been postulated that this is an ex vivo artifact due to the force of knife with the premise that STAS is clinically unimportant and it should be ignored like true artifacts.
Methods:
We present three cases providing evidence that STAS is not an artifact and is clinically relevant.
Results:
Case 1: 68F underwent wedge resection of a left upper lobe (LUL) lung adenocarcinoma. During the surgical procedure the surgeon did not cut across the tumor, but sent a separate wedge biopsy as an additional margin. The latter wedge contained an 8 mm focus of adenocarcinoma consisting almost entirely of a STAS pattern with a 1mm area of acinar growth. Case 2: 66M underwent RUL wedge resection in August 2013 for a 1.3 cm lung adenocarcinoma. The resection margin was positive with only STAS in the margin. In the absence of any clinical sign of recurrence or metastases, a completion right upper lobectomy was performed revealing three separate foci of residual adenocarcinoma including 1.5 and 1.0 mm acinar areas and a 0.5 mm focus of STAS with N1 and N2 lymph node metastases. Adjuvant chemotherapy and radiation were given. In 2014, the patient developed multiple bilateral nodules and in November underwent LUL wedge resection that showed three foci of adenocarcinoma with a STAS predominant pattern. In July 2016, the patient remains on chemotherapy with slowly growing bilateral nodules. Case 3: A 77M presented with pneumonia and bilateral ground glass opacities with focal consolidation. A biopsy, originally interpreted as benign, showed diffuse involvement by adenocarcinoma with a STAS predominant pattern. The morphology does not explain the consolidation seen on CT indicating the surgeon did not cut across the main tumor area.
Conclusion:
We present three cases which provide evidence that STAS is not an artifact that should be ignored. In two cases the extensive STAS predominant pattern was not a knife cutting artifact because the main tumor was not cut either by the surgeon or pathologist. In the third case, STAS was the only pattern of tumor identified at a wedge resection margin. If this had been ignored, the residual and metastatic tumor would not have been identified delaying introduction of chemotherapy. These findings support the concept that STAS is a clinically important invasive pattern and not an artifact.
