Limited Resection Versus Lobectomy in Early-Stage STAS-Positive Adenocarcinoma

Limited resection may be a surgical treatment option for patients who have stage IA adenocarcinoma with spread through air spaces (STAS). However, lobectomy may be the best choice for patients with larger tumors, such as stage IB disease, according to recent study findings.

Kuan Xu, MD, and colleagues retrospectively analyzed clinicopathologic features of 1566 patients with stage I adenocarcinoma in China from 2017 to 2020. Then they classified the patients according to STAS status and surgical method to evaluate if limited resection predicted poorer survival.

Overall, STAS-positive patients had worse recurrence-free survival (RFS). Before propensity score matching (PSM), there was no significant difference in RFS and overall survival (OS) between limited resection and lobectomy for STAS-negative or STAS-positive patients.

After PSM, RFS was comparable between limited resection (14.6%) and lobectomy (14.1%) in STAS-positive patients with stage I, IA, or IB adenocarcinoma. However, OS was worse in stage I and IB patients who underwent limited resection (91.6%) compared with lobectomy (100%) after 3 years.

“Worse survival in the limited group could be attributed to the advanced-stage tumors and limited resection ordinarily performed in patients with declined lung function,” the study authors said.

Furthermore, adjuvant chemotherapy didn’t improve the outcomes of patients with stage IB STAS-positive disease.