Prediction of STAS positivity in operable non-small cell lung cancer - Original Article - Özgün Makale

Sep 29, 2026

This retrospective study evaluates clinical and pathological predictors of spread through air spaces (STAS) positivity in patients with operable non-small cell lung cancer. Data from 380 surgically resected primary lung cancer cases diagnosed between September 2001 and November 2024 were analyzed. Higher preoperative monocyte counts were significantly associated with STAS positivity. Pathologic N1 and N2 stages and increased lymph node SUVmax were also related to STAS positivity, while multivariate analysis identified adenocarcinoma histology and elevated monocytes as independent predictors.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

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Turkish Journal of Thoracic and Cardiovascular Surgery 2025;33(4):498-506 Orıgınal Artıcle / Özgün Makale Prediction of STAS positivity in operable non-small cell lung cancer Opere edilebilen küçük hücreli dışı akciğer kanserinde STAS pozitifliğinin tahmini Burcu Kılıç1􀀬, Melek Ağkoç2􀀬, Ömer Faruk Sağlam3􀀬, Levani Chikvaidze1􀀬, H. Volkan Kara1􀀬, Kamil Kaynak1􀀬, Akif Turna1􀀬, Ezel Erşen1􀀬 Institution where the research was done: İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye Author Affiliations: 1Department of Thoracic Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye 2Department of Thoracic Surgery, Erzurum City Hospital, Erzurum, Türkiye 3Department of Thoracic Surgery, Tokat State Hospital, Tokat, Türkiye ABSTRACT Background: This study aims to identify clinical and pathological factors associated with spread through air spaces (STAS) positivity in patients with non-small cell lung cancer. Methods: Between September 2001 and November 2024, a total of 380 patients (279 males, 101 females; mean age: 61.6±10.1 years; range, 20 to 87 years) who were diagnosed with primary lung cancer and underwent surgical resection were retrospectively analyzed. Demographic, clinical, and pathological data of the patients were collected and their association with STAS positivity was evaluated. Results: A higher preoperative monocyte count was significantly associated with STAS positivity (0.73±0.63 vs . 0.58±0.22; p=0.003; odds ratio=5.57; 95% confidence interval: 1.76-17.6) . Pathological N1 and N2 stages, along with increased maximum standardized uptake value (SUVmax) in the lymph nodes, were related to STAS positivity. In the multivariate analysis, only adenocarcinoma histology and elevated monocyte count were found to be independently associated with STAS positivity. Conclusion: Adenocarcinoma histology and increased preoperative monocyte levels are independent predictors of STAS in patients with non-small cell lung cancer. Elevated SUVmax values in the lymph nodes may indicate a potential association with STAS positivity. These findings may be a guide for preoperative risk stratification and individualized treatment planning in clinical practice. Keywords: Adenocarcinoma, lymph node metastasis, monocyte count, non-small cell lung cancer, spread through air spaces. ÖZ Amaç: Bu çalışmada küçük hücreli dışı akciğer kanserli hastalarda hava yolu ile tümör yayılımı (STAS) pozitifliği ile ilişkili klinik ve patolojik faktörler belirlendi. Çalışma planı: Eylül 2001 - Kasım 2024 tarihleri arasında primer akciğer kanseri tanısı alan ve cerrahi rezeksiyon yapılan toplam 380 hasta (279 erkek, 101 kadın; ort. yaş: 61.6±10.1 yıl; dağılım, 20-87 yıl) retrospektif olarak incelendi. Hastaların demografik, klinik ve patolojik verileri kaydedildive STAS pozitifliği ile ilişkisi değerlendirildi. Bulgular: Ameliyat öncesi yüksek monosit sayısı STAS pozitifliği ile anlamlı şekilde ilişkili idi (0.73±0.63'e kıyasla 0.58±0.22; p=0.003; olasılık oranı=5.57; %95 güven aralığı: 1.76-17.6) . Patolojik N1 ve N2 hastalık varlığı ile lenf nodlarında yüksek maksimum standart tutulum değeri (SUVmax), STAS pozitifliği ile ilişkili idi. Çok değişkenlianalizde, yalnızca adenokarsinom histolojisi ve yüksek monosit sayısı STAS pozitifliği ile bağımsız olarak ilişkilibulundu . Sonuç: Küçük hücreli dışı akciğer kanseri hastalarında adenokarsinom histopatolojisi ve ameliyat öncesi artmış monosit düzeyleri, STAS varlığının bağımsız öngördürücüleridir. Lenf nodlarındaki artmış SUVmax değeri de, STAS pozitifliğiile muhtemel bir ilişkiye işaret edebilir. Bu bulgular, klinikuygulamada ameliyat öncesi risk değerlendirmesinde ve bireyselleştirilmiş tedavi planlamasında yol gösterici olabilir. Anahtar sözcükler: Adenokarsinom, lenf nodu metastazı, monosit sayısı, küçük hücreli dışı akciğer kanseri, hava yolu ile tümör yayılımı . Corresponding author: H. Volkan Kara.

FAQs

What was the primary goal of the study?

The study aimed to identify clinical and pathological factors associated with STAS positivity in patients with non-small cell lung cancer.

How was the patient cohort analyzed?

A total of 380 patients diagnosed between September 2001 and November 2024 and treated with surgical resection were retrospectively analyzed, with demographic, clinical, and pathological data linked to STAS positivity.

Which factors were independently associated with STAS positivity?

In multivariate analysis, adenocarcinoma histology and elevated preoperative monocyte count were independently associated with STAS positivity.

Sep 29, 2026

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