The correlation between tumor radiological features and spread through air spaces in peripheral stage IA lung adenocarcinoma: a propensity score-matched analysis

Jia et al. Journal of Cardiothoracic Surgery (2024) 19:19 https://doi.org/10.1186/s13019-024-02498-0 Journal of Cardiothoracic Surgery Open Access RESEARCH The correlation between tumor radiological features and spread through air spaces in peripheral stage IA lung adenocarcinoma: a propensity score-matched analysis Chao Jia1†, Hai-Cheng Jiang2†, Cong Liu3,4, Yu-Feng Wang5, Hong-Ying Zhao6, Qiang Wang7, Xiu-Qing Xue8* and Xiao-Feng Li1,9* Abstract Background The consolidation tumor ratio (CTR) is a predictor of invasiveness in peripheral T1N0M0 lung adenocarcinoma. However, its association with spread through air spaces (STAS) remains largely unexplored. We aimed to explore the correlation between the CTR of primary tumors and STAS in peripheral T1N0M0 lung adenocarcinoma. Methods We collected data from patients who underwent surgery for malignant lung neoplasms between January and November 2022. Univariate and multivariate analyses following propensity-score matching with sex, age, BMI, were performed to identify the independent risk factors for STAS. The incidence of STAS was compared based on pulmonary nodule type. A smooth fitting curve between CTR and STAS was produced by the generalized additive model (GAM) and a multiple regression model was established using CTR and STAS to determine the dose-response relationship and calculate the odds ratio (OR) and 95% confidence interval (CI). Results 17 (14.5%) were diagnosed with STAS. The univariate analysis demonstrated that the history of the diabetes, size of solid components, spiculation, pleural indentation, pulmonary nodule type, consolidation/tumor ratio of the primary tumor were statistically significant between the STAS-positive and STAS-negative groups following propensity-score matching(p = 0.047, 0.049, 0.030, 0.006, 0.026, and < 0.001, respectively), and multivariate analysis showed that the pleural indentation was independent risk factors for STAS (with p-value and 95% CI of 0.043, (8.543– 68.222)). Moreover, the incidence of STAS in the partially solid nodule was significantly different from that in the solid nodule and ground-glass nodule (Pearson Chi-Square = 7.49, p = 0.024). Finally, the smooth fitting curve showed that CTR tended to be linearly associated with STAS by GAM, and the multivariate regression model based on CTR showed an OR value of 1.24 and a p-value of 0.015. † Chao Jia and Hai-Cheng Jiang are co-first authors. *Correspondence: Xiu-Qing Xue Xiao-Feng Li Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Jia et al. Journal of Cardiothoracic Surgery (2024) 19:19 Page 2 of 8 Conclusions In peripheral stage IA lung adenocarcinoma, the risk of STAS was increased with the solid component of the primary tumor. The pleural indentation of the primary tumor could be used as a predictor in evaluating the risk of the STAS. Keywords Adenocarcinoma, Consolidation tumor ratio, Tumor spread through air spaces, Odds ratio Background Multiple clinical studies have shown that screening with low-dose computed tomography (LDCT) can lower the mortality rate of lung cancer and improve prognosis [1–3]. With the widespread use of LDCT for lung cancer screening in high-risk populations, the incidence of early-stage lung cancer is gradually increasing. LDCT has a detection rate of about 3.48% for lung cancer, with 81.09% of cases being stage I cancer [3]. Non-small-cell lung cancer (NSCLC) comprises 80–85% of all types of lung cancer [4, 5], with adenocarcinoma being the predominant pathological subtype, accounting for approximately 40% [6]. For stage IA lung adenocarcinoma, radical resection is still the preferred and recommended treatment according to guidelines [7, 8]. In 2020, Yasuhiro [9] has proposed that sublobar resection for stage IA lung adenocarcinoma can achieve a prognosis that is not inferior to that of lobectomy. However, the heterogeneity of malignant tumors still leads to differences in long-term prognosis after surgery [10]. Suzuki [11] has suggested that sublobar resection may be more suitable for patients with less-invasiveness stage IA lung adenocarcinoma. Therefore, recognizing lessinvasiveness stage IA lung adenocarcinoma preoperative has become a significant challenge for thoracic surgeons [12]. Our previous research has confirmed that sublobar resection is more suitable for patients with less-invasiveness stage IA lung adenocarcinoma based on the metabolic parameters of the primary tumor [13]. In recent years, spread through air spaces (STAS) as a manifestation of early lung cancer has received increasing attention from clinical researchers [12, 14]. Previous studies [14] have shown that STAS can increase the recurrence rate after limited resection for stage IA lung adenocarcinoma, making it an essential feature of the invasion of stage IA lung adenocarcinoma. Consolidation tumor ratio (CTR) is defined as the ratio of the maximum size of a solid component to the maximum tumor size in the primary tumor and can be used to predict the invasion of peripheral stage IA lung adenocarcinoma lesions. Moreover, according to Suzuki [11], CTR ≤ 0.25 can serve as a less invasive means of identifying lung adenocarcinoma lesions in the peripheral stage IA. Currently, there are many clinical studies about CTR with STAS [15, 16], previous study confirmed that the CTR of primary tumor was association with STAS-positive tumors [15, 17]. However, it is still lack of the clinical evidence of CTR with STAS in peripheral stage IA lung adenocarcinoma. We aimed to investigate the correlation between the primary tumor CTR and STAS in patients with peripheral stage IA lung adenocarcinoma. Methods Study population and data collection This study was a retrospective analysis of data from consecutive malignant lung neoplasm patients who underwent surgical resection at Xuzhou Hospital affiliated with Jiangsu University (...truncated)