WCLC 2025 - Posters & ePosters-EP.06.40 The Role of Histology and Metabolic Parameters in Predicting Spread Through Air Spaces

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This retrospective study analyzed 224 NSCLC patients who underwent anatomical lung resection between 2018 and 2023 to identify clinical, pathological, and metabolic predictors of spread through air spaces (STAS), a factor linked to prognosis. Excluding patients with ground-glass opacity tumors, minimally invasive adenocarcinoma (MIA), adenocarcinoma in situ (AIS), distant metastases, and those receiving neoadjuvant therapy, only patients with pre-operative 18-FDG PET scans were included. PET parameters analyzed included SUVmax, SUVmean, SUVpeak, total lesion glycolysis (TLG), and metabolic tumor volume (MTV).<br /><br />Univariable analysis showed no significant correlation between STAS presence and clinical factors such as sex, age, smoking history, tumor location, tumor size, histology subtype, or PET metabolic parameters. However, a significant association was found between STAS and higher tumor grading (grade 3 vs. grades 1–2; p=0.001) and high-grade adenocarcinoma subtypes (papillary, micropapillary, solid; p=0.003). Lymphovascular invasion showed a borderline association (p=0.053). <br /><br />Multivariable logistic regression identified tumor grading as an independent predictor of STAS (grade 3 tumors had 5.44 times higher odds of STAS, 95% CI 1.75–16.84; p=0.003). Adenocarcinoma subtype and lymphovascular invasion were not independently significant in the multivariable model.<br /><br />The study concludes that metabolic PET parameters are not predictive of STAS in NSCLC, whereas histological factors—particularly tumor grade—can stratify risk for STAS. These findings suggest that preoperative histological assessment can guide surgical planning and follow-up strategies to improve management of NSCLC patients with potential STAS involvement.

Asset Subtitle

Filippo Lococo

Meta Tag

Speaker Filippo Lococo

Topic Pathology and Biomarkers

Keywords

NSCLC

spread through air spaces

STAS

tumor grading

adenocarcinoma subtype

18-FDG PET

SUVmax

metabolic tumor volume

lymphovascular invasion

retrospective study