Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification
Abstract It has not been determined which descriptor spread through air spaces (STAS) should be incorporated into the context of the ninth Tumor, Node and Metastasis (TNM) staging system: the T or the uncertain resection [R(un)] category. A multicenter retrospective cohort of 807 patients with patho...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-07-01
|
| Series: | The Journal of Pathology: Clinical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/2056-4538.70039 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850080557157842944 |
|---|---|
| author | Yedong Mi Donglai Chen Zhangqiang Chen Yue Li Xiaoxiao Dai Shanshan Shen Jian Shu Yongzhong Li Lijie Tan Yiming Mao Qifeng Ding Yongbing Chen |
| author_facet | Yedong Mi Donglai Chen Zhangqiang Chen Yue Li Xiaoxiao Dai Shanshan Shen Jian Shu Yongzhong Li Lijie Tan Yiming Mao Qifeng Ding Yongbing Chen |
| author_sort | Yedong Mi |
| collection | DOAJ |
| description | Abstract It has not been determined which descriptor spread through air spaces (STAS) should be incorporated into the context of the ninth Tumor, Node and Metastasis (TNM) staging system: the T or the uncertain resection [R(un)] category. A multicenter retrospective cohort of 807 patients with pathological stage I lung adenocarcinoma was included in this study to assess the feasibility of incorporating STAS into the T descriptor or the R(un) category by analyzing recurrence‐free survival (RFS) and overall survival (OS). Decision curve analysis (DCA) was performed to evaluate the standardized net benefit of the proposed T (nT) and that of the proposed residual tumor classification (nR) versus the current staging systems. Log‐rank tests indicated that patients with pT1/STAS‐positive lung adenocarcinoma had similar RFS and OS to patients with pT2a disease irrespective of R status. Regarding STAS as an indicator for upgrading R0 to R(un), comparable survival was observed between pT1‐2a/STAS‐positive patients undergoing R0 segmentectomy and pT1‐2a patients undergoing R(un) segmentectomy. We further assessed the effects of the combination of STAS with either T or R category on survival in a validation cohort. Subgroup analyses stratified by surgical procedures further identified the consistency of the nT category in discriminating RFS and OS. However, the separation of nR0 and nR(un) disease in pT2a tumors treated by lobectomy or segmentectomy was not sufficiently distinguished. DCA further corroborated a greater predictive capability of nT versus the current T category. In conclusion, STAS might be preferentially considered as an indicator for upgrading pT1 disease into pT2a in the future TNM staging system. |
| format | Article |
| id | doaj-art-a94ea698c26149c78b88a0e2dfc8c34e |
| institution | DOAJ |
| issn | 2056-4538 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Journal of Pathology: Clinical Research |
| spelling | doaj-art-a94ea698c26149c78b88a0e2dfc8c34e2025-08-20T02:44:55ZengWileyThe Journal of Pathology: Clinical Research2056-45382025-07-01114n/an/a10.1002/2056-4538.70039Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classificationYedong Mi0Donglai Chen1Zhangqiang Chen2Yue Li3Xiaoxiao Dai4Shanshan Shen5Jian Shu6Yongzhong Li7Lijie Tan8Yiming Mao9Qifeng Ding10Yongbing Chen11Department of Thoracic Surgery The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Thoracic Surgery Zhongshan Hospital, Fudan University Shanghai PR ChinaDepartment of Thoracic Surgery The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Thoracic Surgery The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Pathology The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Pathology The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Thoracic Surgery Taicang Affiliated Hospital of Soochow University, The First People's Hospital of Taicang Taicang PR ChinaDepartment of Thoracic Surgery The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Thoracic Surgery Zhongshan Hospital, Fudan University Shanghai PR ChinaDepartment of Thoracic Surgery Suzhou Kowloon Hospital Shanghai Jiaotong University School of Medicine Suzhou PR ChinaDepartment of Thoracic Surgery The Second Affiliated Hospital of Soochow University Suzhou PR ChinaDepartment of Thoracic Surgery The Second Affiliated Hospital of Soochow University Suzhou PR ChinaAbstract It has not been determined which descriptor spread through air spaces (STAS) should be incorporated into the context of the ninth Tumor, Node and Metastasis (TNM) staging system: the T or the uncertain resection [R(un)] category. A multicenter retrospective cohort of 807 patients with pathological stage I lung adenocarcinoma was included in this study to assess the feasibility of incorporating STAS into the T descriptor or the R(un) category by analyzing recurrence‐free survival (RFS) and overall survival (OS). Decision curve analysis (DCA) was performed to evaluate the standardized net benefit of the proposed T (nT) and that of the proposed residual tumor classification (nR) versus the current staging systems. Log‐rank tests indicated that patients with pT1/STAS‐positive lung adenocarcinoma had similar RFS and OS to patients with pT2a disease irrespective of R status. Regarding STAS as an indicator for upgrading R0 to R(un), comparable survival was observed between pT1‐2a/STAS‐positive patients undergoing R0 segmentectomy and pT1‐2a patients undergoing R(un) segmentectomy. We further assessed the effects of the combination of STAS with either T or R category on survival in a validation cohort. Subgroup analyses stratified by surgical procedures further identified the consistency of the nT category in discriminating RFS and OS. However, the separation of nR0 and nR(un) disease in pT2a tumors treated by lobectomy or segmentectomy was not sufficiently distinguished. DCA further corroborated a greater predictive capability of nT versus the current T category. In conclusion, STAS might be preferentially considered as an indicator for upgrading pT1 disease into pT2a in the future TNM staging system.https://doi.org/10.1002/2056-4538.70039STASTNM staging systemR classificationsurgical procedure |
| spellingShingle | Yedong Mi Donglai Chen Zhangqiang Chen Yue Li Xiaoxiao Dai Shanshan Shen Jian Shu Yongzhong Li Lijie Tan Yiming Mao Qifeng Ding Yongbing Chen Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification The Journal of Pathology: Clinical Research STAS TNM staging system R classification surgical procedure |
| title | Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification |
| title_full | Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification |
| title_fullStr | Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification |
| title_full_unstemmed | Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification |
| title_short | Which descriptor should spread through air spaces (STAS) be incorporated into? T descriptor versus residual tumor classification |
| title_sort | which descriptor should spread through air spaces stas be incorporated into t descriptor versus residual tumor classification |
| topic | STAS TNM staging system R classification surgical procedure |
| url | https://doi.org/10.1002/2056-4538.70039 |
| work_keys_str_mv | AT yedongmi whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT donglaichen whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT zhangqiangchen whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT yueli whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT xiaoxiaodai whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT shanshanshen whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT jianshu whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT yongzhongli whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT lijietan whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT yimingmao whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT qifengding whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification AT yongbingchen whichdescriptorshouldspreadthroughairspacesstasbeincorporatedintotdescriptorversusresidualtumorclassification |