Abstract: Objective To investigate the effect of spread through air spaces (STAS) of lung adenocarcinoma on the selection of lobectomy and sublobar resection and postoperative survival outcomes.Methods A retrospective analysis was performed on 196 patients with lung adenocarcinoma admitted to our hospital from October 2018 to October 2022.According to the STAS diagnostic criteria,they were divided into a STAS-positive group (121 cases) and a STAS-negative group (75 cases).The clinical data,surgical methods,and follow-up data of the patients were collected,and the clinical characteristics,surgical selection,and survival outcomes of the two groups were compared.The effect of STAS status on prognosis under different surgical methods was further compared.Results Compared with the STAS-negative group,patients in the STAS-positive group presented with larger tumor diameters,higher rates of vascular,pleural,perineural,and lymphovascular infiltration and tumor necrosis,higher pathological stages,and a higher rate of lobectomy (P<0.05).Multivariate Logistic regression analysis showed that STAS status,maximum tumor diameter,vascular invasion,lymphovascular invasion,and pathological stage were independent factors affecting the surgical procedure selection (lobectomy vs sublobar resection) in patients with lung adenocarcinoma (P<0.05).The recurrence rate and mortality rate in the STAS-positive group were 40.50% (49/121) and 16.53% (20/121),respectively,which were significantly higher than those in the STAS-negative group (14.67% (11/75) and 5.33% (4/75)) (P<0.05).In the STAS-positive group,the recurrence rate and mortality rate of patients undergoing sublobar resection were significantly higher than those undergoing lobectomy (both P<0.05);while in the STAS-negative group,there was no statistically significant difference in recurrence rate and mortality between the two surgical procedures (P>0.05).Conclusion For the STAS-negative patients,there is no difference in prognosis between lobectomy and sublobar resection;however,for the STAS-positive patients,lobectomy offers a better prognosis than sublobar resection.

Key words: lung adenocarcinoma, spread through air spaces, lobectomy, sublobar resection, prognosis