Spread Through Air Spaces (STAS) as a Predictive and Prognostic Factor in Patients with Non-Small Cell Lung Cancer—Systematic Review

Background/Objectives: Lung cancer is the second most prevalent cancer in the general population and the third most prevalent among women. STAS (Spread Through Air Spaces) is a term used in pathology, particularly in lung cancer. It refers to the spread of tumor cells through air spaces in the lung tissue. The aim of this study was to evaluate the utility of STAS as a predictive and prognostic factor, as well as to assess the impact of STAS detection on subsequent surgical and pharmacological treatment decisions. Methods: A comprehensive literature search was performed on PubMed, PMC, and Google Scholar between June and September 2024. Search terms included ‘STAS’, ‘lung cancer’, ‘NSCLC’, ‘SCLC’, ‘PET and STAS’, ‘histopathological STAS’, ‘treatment methods for STAS’, and ‘STAS prognosis’. A diverse range of study designs was included in our analysis—encompassing meta-analyses, case-control studies, literature reviews, cross-sectional studies, and prospective longitudinal studies. Results: Lobectomy remains standard, whereas sublobar resection significantly increases recurrence risk in STAS-positive patients. CT, PET/CT, and frozen section analysis offer emerging, reliable predictive markers, supporting optimized treatment selection; however, histopathological examination continues to serve as the standard method for confirming STAS. Conclusions: One of the most significant limitations of our work is the limited number of available studies addressing the topic of STAS, which is the reason why statistical analysis was not provided. To conclude, the presence of STAS is identified as a negative prognostic factor amongst patients with NSCLC; however further research is needed to establish specific treatment guidelines when STAS is identified.