WCLC 2025 - Posters & ePosters-EP.04.23 Prediction of STAS Positivity in Non-Small Cell Lung Cancer

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This retrospective study from Istanbul University-Cerrahpaşa examined predictors of spread through air spaces (STAS) positivity in operable non-small cell lung cancer (NSCLC). STAS, defined as tumor cells present in alveolar spaces beyond the primary tumor edge, is linked to poorer prognosis and higher recurrence. Identifying preoperative indicators of STAS is critical for risk assessment and surgical planning.<br /><br />The study analyzed 380 NSCLC patients (279 males, 101 females, mean age ~62 years) who underwent lobectomy, segmentectomy, or wedge resection between 2001 and 2024, with complete STAS data. Using univariate and multivariate logistic regression and ROC curve analysis, the team assessed clinical and pathological factors related to STAS positivity.<br /><br />STAS was observed in 49.5% (188/380) of patients. Multivariate analysis revealed two strong independent predictors for STAS positivity: adenocarcinoma histology (odds ratio [OR] 2.71, p=0.005) and elevated preoperative monocyte count (OR 15.12, p<0.001). Although lymph node maximum standardized uptake value (SUVmax) showed significance in univariate analysis (p=0.034), it was not an independent predictor in multivariate models, with a moderate discriminative ability (AUC=0.592). Patients without STAS had higher rates of excessive phlegm (16.7% vs. 6.9%, p=0.003). No significant differences emerged in C-reactive protein, lactate dehydrogenase, FEV1, white blood cell count, or neutrophils.<br /><br />The study concludes that adenocarcinoma histology and higher monocyte levels are key preoperative predictors of STAS in NSCLC, underscoring the role of inflammation markers alongside histology in anticipating aggressive tumor behavior. Integrating PET/CT imaging and blood count data into clinical evaluation may improve individualized surgical planning and potentially optimize patient outcomes in operable NSCLC.

Asset Subtitle

Burcu Kilic

Meta Tag

Speaker Burcu Kilic

Topic Screening and Early Detection

Keywords

spread through air spaces

STAS

non-small cell lung cancer

NSCLC

adenocarcinoma histology

preoperative monocyte count

lobectomy

segmentectomy

wedge resection

PET/CT imaging