Highlights from

World Conference on Lung Cancer

19th annual meeting

Toronto, Canada 23-26 September 2018

Spread through air spaces is prognostic in lung neuroendocrine tumours

Aly et al. previously reported that spread through air spaces (STAS) is associated with a worse prognosis in resected lung adenocarcinoma and squamous cell carcinoma [2, 3]. The aim of the current study was to investigate the incidence and prognostic impact of STAS in lung neuroendocrine tumours [4]. All tumour slides (median 3, range 2-7) from patients with primary lung neuroendocrine tumours (n=628) were evaluated for the presence of STAS. Cohorts included typical carcinoid (TC, n=305), atypical carcinoid (AC, n=38), large-cell neuroendocrine carcinoma (LCNEC, n=93), and small-cell lung carcinoma (SCLC, n=57). Patients with combined neuroendocrine tumours were excluded from the study (n=19). Aly et al. used the competing risks approach to analyse the cumulative incidence of recurrence and lung cancer-specific cumulative incidence of death.

STAS was identified in 25% neuroendocrine tumours. The TC cohort accounted for 15%; AC, 37%; LCNEC, 43%; SCLC, 46%. There were too few events (≤5) in the TC cohort to do a prognostic analysis. Patients with STAS-positive tumours were associated with higher cumulative incidence of recurrence than those with STAS-negative ones. That was so in the total AC-LNEC-SCLC cohort and in the individual AC, LNEC, and SCLC cohorts (Figure 13, A-D). STAS was also associated with higher lung cancer-specific cumulative incidence of death in all cohorts except AC (Figure 13, E-H).

[Figure 13] (A-D and E-H) Five-year cumulative incidence of recurrence and lung cancer-specific cumulative incidence of eath in patients with STAS-positive vs STAS-negative tumours

WCLC 2018: Figure 13 A-D

Multivariate analysis found that STAS was also an independent risk factor for recurrence and lung cancer-specific death, independent of stage and histologic subtype. Stratified by stage, STAS was an independent predictor of recurrence (subhazard ratio [SHR] 2.39; P=0.007) and lung cancer-specific death in LCNEC (SHR 2.42; P=0.012). STAS was also an independent risk factor of lung cancer-specific death in SCLC.

The data show that STAS is a significant prognostic variable in individual neuroendocrine tumour subtypes (AC, LCNEC, and SCLC) as well as adenocarcinoma and squamous cell carcinoma. It is associated with early and distant metastasis in lung neuroendocrine tumours and is also an independent prognostic factor for cumulative incidence of recurrence and lung cancer-specific cumulative incidence of death. The high clinical utility of STAS supports its detection in all major histologic types of lung cancer.

  1. Travis WD, J Thorac Oncol 2015;10:1243-1260.
  2. Kadota K, et al. J Thorac Oncol 2015;10:806-814.
  3. Kadota K, et al. Abstract MA22.05. IASLC 19th WCLC. 23-26 September 2018, Toronto, Canada.

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