如何准确定义肺腺癌的“气腔播散”

How to refine a precise definition of spread through air spaces in lung adenocarcinoma?

从“肿瘤岛”的研究到肿瘤“气腔播散”被世界卫生组织纳为肺腺癌的一种浸润方式经历了较短的时间。肿瘤气腔播散(STAS)是指:肿瘤细胞扩散至主肿瘤边缘外的肺实质气腔中。越来越多的研究表明,STAS可增加肿瘤的复发率并预示不良预后。然而,STAS的定义在此前的研究中是各不相同的;到目前为止,STAS尚未形成统一定义。此外,包括标本处理和手术过程在内的围手术期操作均有可能造成肿瘤细胞脱落的“人工假象”而影响STAS。显然,我们需要一个精确的定义来减少和量化混杂因素的影响。本文对近年来的研究进展进行了总结,并提出了进一步研究的建议。

It was a short time from the initial investigation of tumor islands to the concept of tumor spread through air spaces(STAS)being adopted as a pattern of invasion in lung adenocarcinoma.Generally,STAS was defined as"spread of lung cancer cells into air spaces in the lung parenchyma beyond the edge of the main tumor".More and more studies had demonstrated that STAS could increase recurrence rate and cause worse prognosis in lung adenocarcinoma.However,criteria of this definition were various in previous studies,and there is no unified criterion of STAS up to now.In addition,perioperative manipulations including specimen processing and surgery procedure could squeeze tumor cells into alveolar spaces which could affect the assessment of STAS.Obviously,we need a precise definition to reduce and quantify the impacts of confounding factors.We summarize recent developments and put forward some advice for further studies in this article.