Clinical Effect Of Tumor Spread Through Air Spaces On Prognosis In Non-small Cell Lung Cancer:a Meta-analysis Of21 Studies

Objective: To analyze and explore the potential influence and role of tumor spread through air spaces(STAS)as a prognostic indicator of surgery in non-small cell lung cancer(NSCLC).Methods: Computer search of Pub Med、Web of Science、EMbase、Cochrane,the search date is from the establishment of the database to December 2020.The5-year overall survival(OS)and 5-year recurrence free survival(RFS)of NSCLC patients with or without STAS were compared according to the pre-defined criteria.The risk ratio(HR)and 95% confidence interval(CI)were used as effective indicator to evaluate the quality of each study.The Newcastle Ottawa scale(NOS)was used to evaluate the quality of each study.Results: A total of 21 studies were included,with a total of 5714 patients.The number of STAS-positive patients was 1701(29.8%).Meta-analysis results show that the presence of STAS can cause a worse prognosis of 5-year RFS for lung cancer patients,with a combined HR of 2.03(95% CI: 1.73-2.38),and the meta-analysis of 15 studies showed that patients with STAS were associated with a shorter 5-year OS.The 5-year OS was significantly correlated,the combined HR was 2.37(95% CI: 1.93 to 2.90),and there was no significant statistical heterogeneity in all the included literature.Subgroup analysis showed that after grouping by region,median age,pathological type,staging,and surgical method,patients in the STAS positive group were still associated with worse 5-year RFS and OS.Conclusion: The existence of STAS can cause worse prognosis for patients undergoing NSCLC surgery,which is an independent risk factor.Adequate attention should be paid and recorded in the pathology report to guide comprehensive treatment and evaluate the prognosis of patients.