The Effect of STAS Positivity in Lung Cancer

STAS in Lung Cancer




non-small cell lung cancer; spread through air space ; prognosis


Aim : 

The spread through air spaces (STAS) phenomenon, which describes the presence of tumor cells in the air spaces of lung cancer, has been associated with an increased risk of local recurrence. We performed retrospective analyses to examine the presence of STAS in lung cancer and to evaluate its clinical results and its relationship with clinicopathological parameters.

Materials and Methods:

A total of 149 surgically resected lung cancer cases were analyzed retrospectively. Detailed analyses were performed on demographic- radiological-clinical-histological features.


The mean age of the patients was 63 (IQR = 11; range, 22–81), among whom 31 were female and 118 were male. The incidence of STAS was not different between the histological groups (p=0.427). There was no difference between SUVmax value in STAS-positive and negative patients (p = 0.970). The recurrence rate, survival, and median tumor size were not different from each other in the STAS-positive and STAS-negative groups (p = 1,000, p = 0.086, p = 0.292, respectively).


STAS is an independent risk factor for poor prognosis. Therefore, it may be possible to provide more personalized information by using clinicopathological markers that will facilitate preoperative prediction of STAS presence.


Download data is not yet available.


Kadota K, Nitadori JI, Sima CS, Ujiie H, Rizk NP, Jones DR, Adusumilli PS, Travis WD. Tumor Spread through Air Spaces is an Important Pattern of Invasion and Impacts the Frequency and Location of Recurrences after Limited Resection for Small Stage I Lung Adenocarcinomas. J Thorac Oncol. 2015 May;10(5):806-814..

Jia M, Yu S, Gao H, Sun PL. Spread Through Air Spaces (STAS) in Lung Cancer: A Multiple-Perspective and Update Review. Cancer Manag Res. 2020 Apr 23;12:2743-2752.

Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma. Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):567-72.

Morimoto J, Nakajima T, Suzuki H, Nagato K, Iwata T, Yoshida S, Fukuyo M, Ota S, Nakatani Y, Yoshino I. Impact of free tumor clusters on prognosis after resection of pulmonary adenocarcinoma. J Thorac Cardiovasc Surg. 2016 Jul;152(1):64-72.e1.

Lu S, Tan KS, Kadota K, Eguchi T, Bains S, Rekhtman N, Adusumilli PS, Travis WD. Spread through Air Spaces (STAS) Is an Independent Predictor of Recurrence and Lung Cancer-Specific Death in Squamous Cell Carcinoma. J Thorac Oncol. 2017 Feb;12(2):223-234.

Kadota K, Kushida Y, Katsuki N, Ishikawa R, Ibuki E, Motoyama M, Nii K, Yokomise H, Bandoh S, Haba R. Tumor Spread Through Air Spaces Is an Independent Predictor of Recurrence-free Survival in Patients With Resected Lung Squamous Cell Carcinoma. Am J Surg Pathol. 2017 Aug;41(8):1077-1086.

Zeng Y, Zhou L, Jia D, Pan B, Li X, Yu Y. Comprehensive analysis for clarifying transcriptomics landscapes of spread through air spaces in lung adenocarcinoma. Front Genet. 2022 Aug 22;13:900864.

Pyo JS, Kim NY. Clinicopathological Impact of the Spread through Air Space in Non-Small Cell Lung Cancer: A Meta-Analysis. Diagnostics (Basel). 2022 Apr 28;12(5):1112.

Nishimori M, Iwasa H, Miyatake K, Nitta N, Nakaji K, Matsumoto T, Yamanishi T, Yoshimatsu R, Iguchi M, Tamura M, Yamagami T. 18F FDG-PET/CT analysis of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma. Ann Nucl Med. 2022 Oct;36(10):897-903.

Chen LW, Lin MW, Hsieh MS, Yang SM, Wang HJ, Chen YC, Chen HY, Hu YH, Lee CE, Chen JS, Chang YC, Chen CM. Radiomic Values from High-Grade Subtypes to Predict Spread Through Air Spaces in Lung Adenocarcinoma. Ann Thorac Surg. 2022 Sep;114(3):999-1006.

Ding Y, Chen Y, Wen H, Li J, Chen J, Xu M, Geng H, You L, Pan X, Sun D. Pretreatment prediction of tumour spread through air spaces in clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg. 2022 Aug 3;62(3):ezac248. doi: 10.1093/ejcts/ezac248.

Ding Y, Li J, Li X, Xu M, Geng H, Sun D. Impact of preoperative biopsy on tumor spread through air spaces in stage I non-small cell lung cancer: a propensity score-matched study. BMC Pulm Med. 2022 Jul 30;22(1):293.

Zeng H, Tan FW, Yuan ZL, Ren JY, Xu JX, Xue Q. [Analysis of the effect of spread through air spaces on postoperative recurrence-free survival in patients with stage pT1N0M0 lung adenocarcinoma of different tumor size]. Zhonghua Yi Xue Za Zhi. 2022 May 24;102(19):1430-1436. Chinese.

Stögbauer F, Lautizi M, Kriegsmann M, Winter H, Muley T, Kriegsmann K, Jesinghaus M, Baumbach J, Schüffler P, Weichert W, Kacprowski T, Boxberg M. Tumour cell budding and spread through air spaces in squamous cell carcinoma of the lung - Determination and validation of optimal prognostic cut-offs. Lung Cancer. 2022 Jul;169:1-12.

Dagher S, Sulaiman A, Bayle-Bleuez S, Tissot C, Grangeon-Vincent V, Laville D, Fournel P, Tiffet O, Forest F. Spread Through Air Spaces (STAS) Is an Independent Prognostic Factor in Resected Lung Squamous Cell Carcinoma. Cancers (Basel). 2022 May 3;14(9):2281.

Chen S, Ye T, Yang S, Zhao Y, Zhang Y, Huang Q, Wu H, Hu H, Sun Y, Zhang Y, Xiang J, Wang S, Gu Y, Jin Y, Li Y, Chen H. Prognostic implication of tumor spread through air spaces in patients with pathologic N0 lung adenocarcinoma. Lung Cancer. 2022 Feb;164:33-38.

Ikeda T, Kadota K, Go T, Misaki N, Haba R, Yokomise H. Segmentectomy Provides Comparable Outcomes to Lobectomy for Stage IA Non-small Cell Lung Cancer with Spread through Air Spaces. Semin Thorac Cardiovasc Surg. 2023 Spring;35(1):156-163.

Villalba JA, Shih AR, Sayo TMS, Kunitoki K, Hung YP, Ly A, Kem M, Hariri LP, Muniappan A, Gaissert HA, Colson YL, Lanuti MD, Mino-Kenudson M. Accuracy and Reproducibility of Intraoperative Assessment on Tumor Spread Through Air Spaces in Stage 1 Lung Adenocarcinomas. J Thorac Oncol. 2021 Apr;16(4):619-629.




How to Cite

şengül inan, merve, inan, kubilay, aytekin çelik, ilknur, & karaoğlanoğlu, nurettin. (2023). The Effect of STAS Positivity in Lung Cancer: STAS in Lung Cancer. Chronicles of Precision Medical Researchers, 4(3), 232–236.