• Shintaro Yokoyama, Tomoyuki Murakami, Hiroyuki Tao, Hideko Onoda, Akio Hara, Ryohei Miyazaki, Masashi Furukawa, Masataro Hayashi, Hidetoshi Inokawa, Kazunori Okabe, and Yoshito Akagi.
• Division of Thoracic Surgery, Department of Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan; Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan; Department of Surgery, Kurume University School of Medicine, Kurume, Japan. Electronic address: yokoyama_shintarou@med.kurume-u.ac.jp.
• Chest. 2018 Oct 1; 154 (4): 838-847.

BackgroundTumor spread through air spaces (STAS) has recently been reported as a novel form of lung adenocarcinoma invasion that can negatively affect survival; however, its role in pleomorphic carcinoma remains unclear. The goal of this study was to characterize tumor STAS in pleomorphic carcinoma, including its association with clinicopathologic features and prognosis.MethodsTumor specimens obtained from 35 consecutive patients with pleomorphic carcinoma who underwent surgical resection between 2009 and 2015 were reviewed. Tumor STAS was defined as tumor cells spreading within the air spaces in the surrounding lung parenchyma beyond the edge of the primary tumor.ResultsFourteen patients (40%) had evidence of STAS-positive pleomorphic carcinomas. Three types of morphologic findings were observed: single cells, small tumor cell clusters, and tumor nests. Tumor necrosis tended to be more prevalent in STAS-positive tumors than in STAS-negative tumors (P = .094). Patients with STAS experienced significantly worse recurrence-free survival (P = .005) and overall survival (P = .002) rates than those without STAS. Moreover, multivariate analysis revealed that tumor STAS was an independent risk factor for both recurrence (P = .014) and poor overall survival (P = .042).ConclusionsIn this first study of its kind, tumor STAS in patients with pleomorphic carcinoma was shown to be associated with high recurrence rates and poor survival after surgical resection. Hence, tumor STAS can serve as a predictor of postoperative survival; this information will enable better risk stratification and more effective clinical management of patients with this rare type of tumor.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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