肺癌气腔扩散的研究进展

Advances in research of spreading through air spaces of lung cancer

肺腺癌在多数国家是临床上最常见的肺癌亚型，几乎占到肺癌的一半。2011年国际肺癌研究协会、美国胸科学会及欧洲呼吸学会提出了新的肺腺癌国际多学科分类，细化了肺腺癌的分型，将浸润性肺腺癌根据生长模式进一步分为贴壁为主型、腺泡为主型、乳头为主型、微乳头为主型和实性为主型，世界卫生组织于2015年引进了气腔侵袭的概念，作为其重要组成部分的气腔扩散（STAS）常常发生于肺癌，尤其是早期肺腺癌。STAS是肺癌细胞在肺实质内经气道扩散至肿瘤主灶边缘以外。但STAS是独立于生长模式外的预后因素，也是Ⅰ期肺腺癌局部切除术后局部和远处复发的独立风险因子。因此在术前或术中判断是否存在STAS对于选择肺腺癌的手术方式和术后治疗方案具有重要指导意义。本文就STAS的病理表现、影响因素、机制和临床意义等相关研究进展作一综述。

Lung adenocarcinoma is the most common histology type of lung cancer clinically in many countries. A new in- ternational multidisciplinary classification was proposed by International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society （ISALC/ATS/ERS） in 2011, renewing the classification of lung adenocarcinoma in detail, in which invasive adenocarcinoma were further classified as lepidic-predominant, acinar predominant, papillary predominant, micropapillary predominant and solid predominant according to growth patterns. In 2015, World Health Organiza- tion introduced the concept of ＂ air space invasion＂. As an important constituent part of air space invasion, spreading through air spaces（STAS） often occurs in lung cancer, especially early-stage lung adenocarcinoma. STAS is defined as the ＂ spread of lung cancer cells into air spaces in the lung parenchyma beyond the edge of the main tumor＂. STAS is not only an independent prognostic factor besides growth patterns, but also an independent risk factor of local and distant relapse after limited resection of stageIlung adenocarcinoma. Therefore, it is of great guiding significance to judge the existence of STAS either preoperatively or intraoperatively in order to choose a suitable operation method and postoperative treatment of lung adenocarcinoma. This review mainly focuses on the latest research progress on the pathological appearance, related factors, mechanisms and clinical significance of STAS.