[The effect of tumor spread through air spaces on the prognosis of patients with stage Ⅰ non-small cell lung cancer: a meta-analysis].

Objective: To systematically evaluate the effect of tumor spread through air spaces (STAS) on the prognosis of patients with stage Ⅰ non-small cell lung cancer (NSCLC). Methods: PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database and VIP were searched to collect papers related to NSCLC and STAS published from the establishment of aboves databases to November 2022. Papers were screened according to the inclusion and exclusion criteria, and data were extracted. The 5-year overall survival (OS) and relapse-free survival (RFS) of stage Ⅰ NSCLC patients with or without STAS were compared. HR(95%CI) was used as effective indicator to evaluate the impact of STAS positivity on the prognosis of NSCLC. The quality of each included study was assessed using the Newcast-Ottawa Scale (NOS). Results: A total of 24 papers concerning 29 studies were included according to the inclusion and exclusion criteria, and there was no significant heterogeneity among the included papers(all I2<50%). A total of 10 883 patients with stage Ⅰ NSCLC were included in the studies, of which 3 298 (30.3%) were STAS-positive. The 29 studies showed that STAS-positive patients had a higher risk of 5-year recurrence than STAS-negative patients with stage Ⅰ NSCLC [HR=1.94(95%CI:1.74-2.16)];and a meta-analysis of 17 of the studies showed that that STAS-positive patients had a higher risk of 5-year death [HR=2.09 (95%CI:1.80-2.43)]. Compared with stage Ⅰ NSCLC patients who underwent other surgeries, STAS-positive patients who underwent sublobar resection had a higher risk of 5-year recurrence than patients with other procedures (HR=3.44, 95%CI: 2.49-4.76) and a higher risk of 5-year death (HR=3.40, 95%CI:2.05-5.64); and patients with stage Ⅰ NSCLC who had the pathologic histologic type of squamous carcinoma had a higher risk of 5-year recurrence (HR=2.48,95%CI:1.71-3.60) and a higher risk of 5-year death (HR=3.04, 95%CI: 1.90-4.86) than other patients with the type of squamous lung cancer. Conclusion: STAS positivity is a risk factor of poor prognosis in patients with stage Ⅰ NSCLC, especially for patients underwent sublobar resection or with squamous lung cancer.目的： 系统评价肺泡腔内气道播散（STAS）对Ⅰ期非小细胞肺癌（NSCLC）患者预后的影响。 方法： 计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据及维普等数据库，搜集非小细胞肺癌与STAS相关的文献，检索时限为建库至2022年11月。按纳入及排除标准筛选文献，进行资料提取，通过对比是否存在STAS的Ⅰ期NSCLC患者术后的5年总生存期（OS）和无复发生存期（RFS），使用HR（95%CI）作为有效指标评估STAS阳性对NSCLC预后的影响，并使用纽卡斯-渥太华量表（NOS）评估纳入的每项研究的质量。 结果： 依纳排标准共纳入24篇文献，共29项研究，所纳入文献无明显异质性（均I2<50%）。研究共纳入10 883例Ⅰ期NSCLC患者，其中3 298例（30.3%）为STAS阳性。29项研究结果显示，与STAS阴性Ⅰ期NSCLC患者相比，STAS阳性者5年复发风险更高［合并HR为1.94（95%CI：1.74~2.16）］；而其中17项研究的荟萃分析显示，STAS阳性患者5年死亡风险更高［合并HR为2.09（95%CI：1.80~2.43）］。相比于其他手术的Ⅰ期NSCLC患者，接受亚肺叶切除的STAS阳性患者5年复发风险更高（HR=3.44，95%CI：2.49~4.76），5年死亡风险更高（HR=3.40，95%CI：2.05~5.64）；病理组织学类型为肺鳞癌的Ⅰ期NSCLC患者相比于其他类型患者5年复发风险更高（HR=2.48，95%CI：1.71~3.60），5年死亡风险更高（HR=3.04，95%CI：1.90~4.86）。 结论： STAS阳性是Ⅰ期NSCLC患者预后不良的危险因素，尤其是对于亚肺叶切除和肺鳞癌患者。.