Analysis of clinical characteristics and related factors of primary pulmonary adenocarcinoma with Spread through air space

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Methods To conduct this study, we looked back at the medical records of 200 patients who had primary lung adenocarcinoma and had surgery at our institution between January 2015 and October 2017. Based on whether or not there was concurrent dispersion via air space, they were separated into the non STAS group (153 instances) and the STAS group (47 cases) (STAS). Univariate and multivariate unconditional logistic regression analyses were performed on the obtained patient data to determine the clinical features and relevant variables of STAS in relation to primary lung cancer; Rates of survival were compared between the two groups; STAS was correlated with survival time for those with primary lung adenocarcinoma using the Pearson correlation coefficient. Results Compared with the non STAS group, the proportion of tumor diameter > 3cm, part of solid nodules, solid nodules, clinical stage Ⅲ~Ⅳ, perineural invasion, lymphatic vessel invasion, vascular invasion, pleural invasion, lobulation sign, bronchial sign and vascular cluster sign in the STAS group increased significantly ( P < 0.05); Independent risk variables for STAS-related primary lung adenocarcinoma were tumour size, tumour nodule type, clinical stage, perineural invasion, lymphatic vessel invasion, vascular invasion, and pleural invasion (P < 0.05); Survival rates at 3, 4, and 5 years were substantially lower (P < 0.05) for those with STAS compared to those without STAS (82.98 percent, 70.21 percent, and 68.09 percent, respectively). There was a significant inverse correlation between STAS and survival time in patients with primary lung adenocarcinoma (r=-0.423, P = 0.007). Conclusion STAS associated with primary pulmonary adenocarcinoma mostly occurs in patients with larger tumor diameter, solid nodules, higher clinical stage, perineural infiltration, lymphatic vessel infiltration, vascular invasion, pleural invasion, lobulation sign, bronchial sign, and vascular cluster sign. Many factors contribute to it, and it is directly connected to patients' survival rates, therefore it serves as a valuable benchmark for clinical research and patient care. Primary lung adenocarcinoma Spread through air space Clinical characteristics Related factors Prognosis Introduction According to histological categories, lung cancer may be split into small cell cancer and non-small cell cancer, with lung adenocarcinoma being the most prevalent and predominant form of non-small cell lung cancer [ 1 , 2 ]. Lung cancer is the malignancy with the highest incidence and death globally. Due to the lack of early-stage clinical signs, lung adenocarcinoma is often identified when the disease has already progressed to a more difficult-to-treat intermediate or advanced stage [ 3 ]. Lung cancer early detection rates have increased as a result of both societal progress and advances in imaging technologies. Surgical resection is currently the main means of clinical treatment of early lung adenocarcinoma. Patients' prognoses are mostly determined by the tumor's pathological classification, whether or not it has spread to lymph nodes, and the size of the tumour [ 4 ]. In recent years, it has been found that airway spread through air space (STAS) will also affect the prognosis of patients [ 5 ]. Compared with other cancers, in addition to traditional direct invasion, lymphatic metastasis, and hematogenous metastasis, lung cancer has a special mode of invasion, that is, STAS, which refers to the spread of lung cancer cells in the air space of the lung parenchyma after leaving the boundary of the main tumor lesion including solid cancer nests or single cells and papillary structures, which is more common in the micropapillary predominant subtype and seriously affects the postoperative survival rate and recurrence rate of patients [ 6 , 7 ].At present, the existence of STAS cannot be determined by frozen section, but can only be differentiated and diagnosed by surgical resection specimens, while there are differences in the occurrence of STAS in different subtypes of lung adenocarcinoma [ 8 ]. There is a dearth of research into the clinical features and associated aspects of STAS in lung adenocarcinoma, despite the fact that doing so would greatly benefit the development of clinical treatment strategies for lung adenocarcinoma and the improvement of patients' prognoses. In order to further inform clinical diagnosis and therapy, it is crucial to better understand the characteristics of primary lung adenocarcinoma linked with STAS. Material and methods 1.1 General material Two hundred patients with primary lung adenocarcinoma were selected retrospectively from January 2015 to October 2017 for this study. Patients were categorised into two groups: those with no evidence of concomitant STAS (non-STAS group; 153 cases) and those with STAS (STAS group; 47 cases). The hospital's ethics board gave its stamp of approval to this study. 1.2 Criteria of inclusion and exclusion Inclusion criteria: ① After pathological diagnosis after surgery, all patients were diagnosed with primary lung adenocarcinoma, and the diagnosis of STAS was confirmed in the STAS group. ② patients with complete clinical treatment; ③ Patients without other malignant tumors. Exclusion criteria: ① patients with history of lung surgery and chemoradiotherapy; ② patients whose preoperative examination showed distant metastasis or clinical stage > cT1aཞcN0M0; ③ Patients without mediastinal lymph node clearance and sampling during the operation. 1.3 Data collection Patients' general data were collected, including gender, age, tumor diameter, lesion location, nodule type, clinical stage, histological type, smoking history, alcohol consumption history, tumor family history, operation method, perineural infiltration, lymphatic infiltration, vascular infiltration, pleural infiltration, computed tomography (CT) signs, etc. 1.4 Observational index ① To analyze the clinical characteristics of primary lung adenocarcinoma with STAS; ② To analyze the related factors of primary lung adenocarcinoma complicated with STAS; ③ To compare the survival rates of the two groups; ④ To analyze the correlation between primary lung adenocarcinoma with STAS and the survival rate of patients. 1.5 Statistical methods We used the SPSS 18.0 programme for our statistical study. Data were analysed using a t-test statistic, and the average ± standard error (x̄ ±s) was given; Data reported as either the number of occurrences (N) or a percentage (%) was analysed using the χ2 test. In both univariate and multivariate contexts, Clinical characteristics and associated variables of primary lung adenocarcinoma with STAS were analysed using logistic regression. Patients who were diagnosed with primary lung adenocarcinoma with STAS were analysed for their survival rates using the Pearson correlation coefficient. Outcome 2.1 Adenocarcinoma of the lung, primary: clinical features associated with STAS The percentages of tumor diameter > 3cm, partial solid nodules, solid nodules, clinical stages of stage III–IV, perineural infiltration, lymphatic infiltration, vascular infiltration, pleural infiltration, lobulation sign, bronchial sign and vascular fasciculation sign in the STAS group were significantly higher than those in the non-STAS group and the differences were statistically significant (P < 0.05), as shown in Table 1 . Table 1 Clinical characteristics of primary lung adenocarcinoma with STAS [ n (%) ] Clinical information Non-STAS group (n = 153) STAS group (n = 47) χ 2 value P value Gender Male 71(46.41) 23(48.94) 0.941 0.332 Female 82(53.59) 24(51.06) Age(years) ≤65 81(52.94) 25(53.19) 1.684 0.194 > 65 72(47.06) 22(46.81) Tumor diameter (cm) ≤3 100(65.36) 24(51.06) 8.663 0.000 > 3 53(34.34) 23(48.94) Tumor location Central type 38(24.84) 12(25.53) 0.127 0.722 Peripheral type 115(75.16) 35(74.47) Nodule type Ground glass nodule 46(30.07) 0(0.00) 7.643 0.000 Partial solid nodule 57(37.25) 11(23.40) Solid nodule 50(32.68) 36(76.60) Clinical staging Stage Ⅰ~Ⅱ 132(86.27) 33(70.21) 13.330 0.000 Stage Ⅲ~Ⅳ 21(13.73) 14(29.79) Histological type Acinar type 92(60.13) 24(51.06) 0.124 0.726 Papillary type 33(21.57) 13(27.66) Mural type 6(3.92) 1(2.13) Solid type 21(13.73) 7(14.89) Micropapillary type 1(7.19) 2(4.26) Smoking history Yes 60(39.22) 18(38.30) 0.019 0.889 No 93(60.78) 29(61.70) Alcoholic history Yes 32(20.92) 12(25.53) 1.087 0.297 No 121(79.08) 35(74.47) Family history of tumor Yes 25(16.34) 9(19.15) 0.660 0.416 No 128(83.66) 38(8.09) Operation methods Lobectomy 137(89.54) 42(89.36) 0.057 0.813 Sublobectomy 16(10.46) 5(10.64) Perineural infiltration Yes 4(2.61) 21(44.68) 9.405 0.000 No 149(97.39) 26(55.32) Lymphatic invasion Yes 51(33.33) 31(65.96) 8.997 0.000 No 102(66.67) 16(34.04) Vascular invasion Yes 31(20.26) 21(44.68) 6.539 0.000 No 122(79.74) 26(55.32) Pleural infiltration Yes 58(37.91) 22(46.81) 7.174 0.000 No 95(62.09) 25(53.19) CT sign Cavitary sign 13(1.96) 5(10.64) 3.511 0.060 Lobulation sign 110(71.90) 41(87.23) 7.326 0.006 Burr sign 97(63.40) 32(68.09) 0.564 0.452 Pleural indentation sign 73(47.71) 27(57.45) 2.803 0.093 Bronchial sign 17(11.11) 12(25.53) 11.460 0.000 Vascular convergence sign 137(89.54) 46(97.87) 4.981 0.025 2.2 Analysis of related factors of STAS in primary lung adenocarcinoma Table 2 shows the results of a logistic multivariate analysis, which determined that tumour size, nodule type, clinical stage, perineural invasion, lymphatic invasion, vascular invasion, and pleural invasion were all independently associated with an increased risk of STAS in patients with primary lung adenocarcinoma (P < 0.05). Table 2 Analysis of related factors of STAS in primary lung adenocarcinoma Relevant factors β S.E. Waldχ 2 value P value OR 95% CI Tumor diameter 0.630 0.191 11.240 0.000 1.874 1.297 ~ 2.699 Nodule type 3.918 0.977 16.180 0.000 20.105 7.434 ~ 37.451 Clinical staging 2.610 1.154 5.137 0.021 13.543 1.421 ~ 28.980 Perineural infiltration 0.800 0.242 11.217 0.000 2.224 1.387 ~ 3.539 Lymphatic invasion 1.697 0.512 11.035 0.000 5.212 2.109 ~ 12.841 Vascular invasion 0.786 0.269 8.701 0.001 2.191 1.300 ~ 3.682 Pleural infiltration 0.945 0.424 4.295 0.043 1.028 0.578 ~ 1.785 Burr sign 0.346 0.413 0.703 0.487 1.324 0.583 ~ 3.012 Bronchial sign 0.396 0.331 1.438 0.171 1.583 0.816 ~ 3.058 Vascular convergence sign 1.282 0.767 2.802 0.123 3.295 0.716 ~ 2.217 2.3 Comparison of survival rates All patients were tracked for a full five years. Survival rates at 3, 4, and 5 years were substantially lower for individuals in the STAS group compared to those in the non-STAS group (P < 0.05). Take a look at the third table. Table 3 Comparison of survival rates [ n (%) ] Survival rate Non-STAS group (n = 153) STAS group (n = 47) χ 2 value P value 1-year 149(97.39) 46(97.87) 0.374 0.707 2-year 145(94.77) 44(93.62) 0.461 0.638 3-year 141(92.16) 39(82.98) 4.982 0.041 4-year 137(89.54) 33(70.21) 5.834 0.034 5-year 134(87.58) 32(68.09) 5.769 0.035 2.4 Correlation between STAS and survival rate of patients with primary lung adenocarcinoma Survival time was adversely connected with STAS in primary lung adenocarcinoma (r=-0.423, P = 0.007). Discussion Lung adenocarcinoma is on the rise due to societal progress, shifting eating patterns, worsening air quality, and a larger population of smokers, all of which pose a major risk to human health and safety [ 9 ]. Surgery has a quite significant therapeutic effect on early lung adenocarcinoma, however, with long-term clinical practice, it has been found that even if the patient is operated under the condition of safe resection margin, there is still a high rate of lesion metastasis and recurrence after surgery, and it is not conducive to the prognosis of patients [ 10 ]. STAS is considered to be a novel mode of infiltration, entering the voids of the lung parenchyma around the tumor in the form of single cells or solid nests and micropapillary cell clusters outside the pathological tumor margin to achieve separation from the main tumor tissue, and since 2015, the World Health Organization (WHO) has added STAS in its pathological categorisation of lung cancer, furthermore, several researchers have discovered that individuals with concomitant STAS had a higher risk of distant metastasis and local recurrence following sublobectomy [ 11 , 12 ]. However, few research have looked into the related variables and clinical characteristics of primary lung adenocarcinoma due to STAS. The results of this study showed that primary lung adenocarcinoma associated with STAS was frequent in patients with tumor diameter > 3 cm, partial solid nodules, solid nodules, clinical stage III ~ IV, perineural invasion, lymphatic invasion, vascular invasion, pleural invasion, lobulation sign, bronchial sign, and vascular convergence sign, and the related factors were more, and the causes are analyzed as follows. Zhang et al. [ 13 ] showed that STAS associated with stage CIA lung adenocarcinoma was common in patients with solid, large tumor diameter, lobulation sign, bronchial sign, and vascular convergence sign; STAS positive was shown to be significantly correlated with histological subtype and pathological stage in lung cancer, as demonstrated by Zhong et al. [ 14 ]; in this study, tumor diameter > 3 cm, partial solid nodules, solid nodules, clinical stage III-IV, perineural invasion, lymphatic invasion, vascular invasion, pleural invasion, lobulation sign, bronchial sign, and vascular convergence sign were significantly higher in the STAS group than in the non-STAS group, and further analysis showed that tumor diameter, nodule type, clinical stage, perineural invasion, lymphatic invasion, vascular invasion, and pleural invasion were independent risk factors for STAS associated with primary lung adenocarcinoma, which were basically consistent with Zhang and Zhong et al. Causes local metastasis [ 15 ].Tumor size determines tumor pathology and prognosis to a certain extent, and the larger the tumor diameter, the higher its malignancy may be and the higher the risk of metastasis [ 16 ]. Solid nodules refer to abnormal solid nodules growing in normal tissues and organs of the body, which have a higher density and are more uniform than normal lung tissues, while it has been confirmed that STAS can metastasize through solid cancer nests [ 17 ], so partial solid nodules and solid nodules are associated with a higher risk of STAS compared with ground-glass nodules. The clinical stage takes into account the patient's overall condition and the tumor's malignancy by measuring factors such as the size, extent, depth of invasion of the primary lesion, metastasis of distant and regional lymph nodes, distant metastasis, and involvement of adjacent organs, with a higher clinical stage indicating a more serious condition [ 18 ]. Perineural invasion, also known as nerve invasion, refers to the encasement of the nerve surface by tumor cells, entering or even within the perineurium, or infiltrating the epineurium, infiltrating into any of the three layers of the nerve sheath, or encasement of the peripheral third of the nerve; lymphatic invasion indicates local occurrence of chronic inflammatory infection; vascular invasion refers to the presence of cancer cells at the vessels, indicating that the tumor cells have metastasized or spread to other tissues before resection; pleural invasion refers to a state of pleural invasion by malignant tumors in the thoracic cavity; A bad prognosis is indicated by the presence of perineural invasion, lymphatic invasion, vascular invasion, or pleural invasion, all of which facilitate the spread and metastasis of cancer cells [ 19 , 20 ]. The lobulation sign reflects the dilated growth of the tumor and reflects the different growth rates of cells around the tumor; the bronchial sign is more common in the lung parenchyma; the vascular convergence sign refers to the connection or convergence of large vessels and small trachea with the lesion, which can enter the nodule or concentrate to the nodule once organ lesions occur; and STAS is the dissemination of cancer cells into the lung parenchyma around the tumor by alveolar and bronchiolar channels [ 21 , 22 ]. In addition to the aforementioned, patients with lung adenocarcinoma should pay close attention to the tumor's size, the type of nodules present, the patient's clinical stage, the presence of perineural invasion, lymphatic invasion, vascular invasion, pleural invasion, and CT signs, and certain preventative measures have been implemented to reduce the risk of STAS. In their review of the literature, Qu et al. [ 23 ] noted that STAS is a significant predictor for poor prognosis and an independent risk factor for tumour recurrence following surgery for lung cancer. in this study, compared with the non-STAS group, the 3-year, 4-year and 5-year survival rates of the STAS group were significantly lower, and primary lung adenocarcinoma associated with STAS was negatively correlated with patient survival, consistent with the results of Qu study, indicating that primary lung adenocarcinoma associated with STAS is closely related to patient prognosis, and the reason was analyzed: STAS can not only interfere with the effect of surgical treatment in patients with early lung cancer, but also predict that the cancer has infiltrated and is more likely to have short-term recurrence [ 24 , 25 ]. In order to decrease postoperative recurrence, decrease mortality, and enhance patients' prognoses, it is advised to increase the degree of resection in accordance with the aforementioned clinical guidelines. The sample size chosen for this study is too little, and as a result, the data in the results may differ from the actual value. Therefore, additional samples should be gathered later to confirm the study's findings.In conclusion, the prognosis of patients with primary lung adenocarcinoma associated with STAS is strongly correlated with tumour size, nodule type, clinical stage, perineural invasion, lymphatic invasion, vascular invasion, and pleural invasion. Declarations Funding None Conflicts of Interest The authors declared that they have no conflicts of interest regarding this work. Ethical Approval and Consent to Participate The protocol for this study was approved by the Ethics Committee of The First Affiliated Hospital of Wenzhou Medical University (Approval No. 014562). All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all individual participants involved in the study. Clinical trial number Not applicable Data Availability Statement The data used to support the findings of this study are available from the corresponding author upon request. References Wang QH, Li ML, Yang M, et al. Analysis of immune-related signatures of lung adenocarcinoma identified two distinct subtypes: implications for immune checkpoint blockade therapy [J]. Aging. 2020;12(4):3312–39. Luan T, Zhang TY, Lv ZH, et al. The lncRNA ALMS1-IT1 may promote malignant progression of lung adenocarcinoma via AVL9-mediated activation of the cyclin-dependent kinase pathway [J]. FEBS Open Bio. 2021;11(5):1504–15. Jin CY, Du L, Nuerlan AH, et al. High expression of RRM2 as an independent predictive factor of poor prognosis in patients with lung adenocarcinoma [J]. Aging. 2020;13(3):3518–35. He BX, Song YX, Wang LL, et al. 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Lung cancer is the malignancy with the highest incidence and death globally. Due to the lack of early-stage clinical signs, lung adenocarcinoma is often identified when the disease has already progressed to a more difficult-to-treat intermediate or advanced stage [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Lung cancer early detection rates have increased as a result of both societal progress and advances in imaging technologies. Surgical resection is currently the main means of clinical treatment of early lung adenocarcinoma. Patients' prognoses are mostly determined by the tumor's pathological classification, whether or not it has spread to lymph nodes, and the size of the tumour [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In recent years, it has been found that airway spread through air space (STAS) will also affect the prognosis of patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Compared with other cancers, in addition to traditional direct invasion, lymphatic metastasis, and hematogenous metastasis, lung cancer has a special mode of invasion, that is, STAS, which refers to the spread of lung cancer cells in the air space of the lung parenchyma after leaving the boundary of the main tumor lesion including solid cancer nests or single cells and papillary structures, which is more common in the micropapillary predominant subtype and seriously affects the postoperative survival rate and recurrence rate of patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].At present, the existence of STAS cannot be determined by frozen section, but can only be differentiated and diagnosed by surgical resection specimens, while there are differences in the occurrence of STAS in different subtypes of lung adenocarcinoma [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There is a dearth of research into the clinical features and associated aspects of STAS in lung adenocarcinoma, despite the fact that doing so would greatly benefit the development of clinical treatment strategies for lung adenocarcinoma and the improvement of patients' prognoses. In order to further inform clinical diagnosis and therapy, it is crucial to better understand the characteristics of primary lung adenocarcinoma linked with STAS.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 General material\u003c/h2\u003e \u003cp\u003eTwo hundred patients with primary lung adenocarcinoma were selected retrospectively from January 2015 to October 2017 for this study. Patients were categorised into two groups: those with no evidence of concomitant STAS (non-STAS group; 153 cases) and those with STAS (STAS group; 47 cases). The hospital's ethics board gave its stamp of approval to this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Criteria of inclusion and exclusion\u003c/h2\u003e \u003cp\u003eInclusion criteria: ① After pathological diagnosis after surgery, all patients were diagnosed with primary lung adenocarcinoma, and the diagnosis of STAS was confirmed in the STAS group. ② patients with complete clinical treatment; ③ Patients without other malignant tumors.\u003c/p\u003e \u003cp\u003eExclusion criteria: ① patients with history of lung surgery and chemoradiotherapy; ② patients whose preoperative examination showed distant metastasis or clinical stage\u0026thinsp;\u0026gt;\u0026thinsp;cT1aཞcN0M0; ③ Patients without mediastinal lymph node clearance and sampling during the operation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Data collection\u003c/h2\u003e \u003cp\u003ePatients' general data were collected, including gender, age, tumor diameter, lesion location, nodule type, clinical stage, histological type, smoking history, alcohol consumption history, tumor family history, operation method, perineural infiltration, lymphatic infiltration, vascular infiltration, pleural infiltration, computed tomography (CT) signs, etc.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Observational index\u003c/h2\u003e \u003cp\u003e① To analyze the clinical characteristics of primary lung adenocarcinoma with STAS; ② To analyze the related factors of primary lung adenocarcinoma complicated with STAS; ③ To compare the survival rates of the two groups; ④ To analyze the correlation between primary lung adenocarcinoma with STAS and the survival rate of patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Statistical methods\u003c/h2\u003e \u003cp\u003eWe used the SPSS 18.0 programme for our statistical study. Data were analysed using a t-test statistic, and the average\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error (x̄ \u0026plusmn;s) was given; Data reported as either the number of occurrences (N) or a percentage (%) was analysed using the χ2 test. In both univariate and multivariate contexts, Clinical characteristics and associated variables of primary lung adenocarcinoma with STAS were analysed using logistic regression. Patients who were diagnosed with primary lung adenocarcinoma with STAS were analysed for their survival rates using the Pearson correlation coefficient.\u003c/p\u003e \u003c/div\u003e"},{"header":"Outcome","content":" \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Adenocarcinoma of the lung, primary: clinical features associated with STAS\u003c/h2\u003e \u003cp\u003eThe percentages of tumor diameter\u0026thinsp;\u0026gt;\u0026thinsp;3cm, partial solid nodules, solid nodules, clinical stages of stage III\u0026ndash;IV, perineural infiltration, lymphatic infiltration, vascular infiltration, pleural infiltration, lobulation sign, bronchial sign and vascular fasciculation sign in the STAS group were significantly higher than those in the non-STAS group and the differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of primary lung adenocarcinoma with STAS [ n (%) ]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eClinical information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-STAS group (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSTAS group (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71(46.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(48.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82(53.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(51.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81(52.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(53.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72(47.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(46.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor diameter (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100(65.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(51.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53(34.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(48.94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentral type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(24.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(25.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeripheral type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115(75.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(74.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNodule type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGround glass nodule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(30.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e7.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial solid nodule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57(37.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(23.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSolid nodule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(32.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36(76.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage Ⅰ~Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132(86.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33(70.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e13.330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage Ⅲ~Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(13.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(29.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHistological type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcinar type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92(60.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(51.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePapillary type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(21.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(27.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMural type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(3.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(2.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSolid type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(13.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(14.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicropapillary type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(7.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(4.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60(39.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(38.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93(60.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29(61.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcoholic history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(20.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(25.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121(79.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(74.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(16.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(19.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128(83.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38(8.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOperation methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137(89.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42(89.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSublobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(10.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(10.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerineural infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(2.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(44.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149(97.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26(55.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLymphatic invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51(33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31(65.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102(66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(34.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31(20.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(44.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122(79.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26(55.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePleural infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58(37.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(46.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95(62.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(53.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eCT sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCavitary sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(10.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLobulation sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110(71.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41(87.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurr sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97(63.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32(68.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePleural indentation sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73(47.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27(57.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBronchial sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(11.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(25.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVascular convergence sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137(89.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46(97.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Analysis of related factors of STAS in primary lung adenocarcinoma\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the results of a logistic multivariate analysis, which determined that tumour size, nodule type, clinical stage, perineural invasion, lymphatic invasion, vascular invasion, and pleural invasion were all independently associated with an increased risk of STAS in patients with primary lung adenocarcinoma (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of related factors of STAS in primary lung adenocarcinoma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelevant factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eS.E.\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWaldχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.297\u0026thinsp;~\u0026thinsp;2.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNodule type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7.434\u0026thinsp;~\u0026thinsp;37.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.421\u0026thinsp;~\u0026thinsp;28.980\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.387\u0026thinsp;~\u0026thinsp;3.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphatic invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.109\u0026thinsp;~\u0026thinsp;12.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.300\u0026thinsp;~\u0026thinsp;3.682\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.578\u0026thinsp;~\u0026thinsp;1.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurr sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.583\u0026thinsp;~\u0026thinsp;3.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchial sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.816\u0026thinsp;~\u0026thinsp;3.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular convergence sign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.716\u0026thinsp;~\u0026thinsp;2.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Comparison of survival rates\u003c/h2\u003e \u003cp\u003eAll patients were tracked for a full five years. Survival rates at 3, 4, and 5 years were substantially lower for individuals in the STAS group compared to those in the non-STAS group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Take a look at the third table.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of survival rates [ n (%) ]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvival rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-STAS group (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSTAS group (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149(97.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(97.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145(94.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44(93.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141(92.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(82.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137(89.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(70.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134(87.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(68.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Correlation between STAS and survival rate of patients with primary lung adenocarcinoma\u003c/h2\u003e \u003cp\u003eSurvival time was adversely connected with STAS in primary lung adenocarcinoma (r=-0.423, P\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLung adenocarcinoma is on the rise due to societal progress, shifting eating patterns, worsening air quality, and a larger population of smokers, all of which pose a major risk to human health and safety [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Surgery has a quite significant therapeutic effect on early lung adenocarcinoma, however, with long-term clinical practice, it has been found that even if the patient is operated under the condition of safe resection margin, there is still a high rate of lesion metastasis and recurrence after surgery, and it is not conducive to the prognosis of patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. STAS is considered to be a novel mode of infiltration, entering the voids of the lung parenchyma around the tumor in the form of single cells or solid nests and micropapillary cell clusters outside the pathological tumor margin to achieve separation from the main tumor tissue, and since 2015, the World Health Organization (WHO) has added STAS in its pathological categorisation of lung cancer, furthermore, several researchers have discovered that individuals with concomitant STAS had a higher risk of distant metastasis and local recurrence following sublobectomy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, few research have looked into the related variables and clinical characteristics of primary lung adenocarcinoma due to STAS. The results of this study showed that primary lung adenocarcinoma associated with STAS was frequent in patients with tumor diameter\u0026thinsp;\u0026gt;\u0026thinsp;3 cm, partial solid nodules, solid nodules, clinical stage III\u0026thinsp;~\u0026thinsp;IV, perineural invasion, lymphatic invasion, vascular invasion, pleural invasion, lobulation sign, bronchial sign, and vascular convergence sign, and the related factors were more, and the causes are analyzed as follows.\u003c/p\u003e \u003cp\u003eZhang et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] showed that STAS associated with stage CIA lung adenocarcinoma was common in patients with solid, large tumor diameter, lobulation sign, bronchial sign, and vascular convergence sign; STAS positive was shown to be significantly correlated with histological subtype and pathological stage in lung cancer, as demonstrated by Zhong et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; in this study, tumor diameter\u0026thinsp;\u0026gt;\u0026thinsp;3 cm, partial solid nodules, solid nodules, clinical stage III-IV, perineural invasion, lymphatic invasion, vascular invasion, pleural invasion, lobulation sign, bronchial sign, and vascular convergence sign were significantly higher in the STAS group than in the non-STAS group, and further analysis showed that tumor diameter, nodule type, clinical stage, perineural invasion, lymphatic invasion, vascular invasion, and pleural invasion were independent risk factors for STAS associated with primary lung adenocarcinoma, which were basically consistent with Zhang and Zhong et al. Causes local metastasis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Tumor size determines tumor pathology and prognosis to a certain extent, and the larger the tumor diameter, the higher its malignancy may be and the higher the risk of metastasis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Solid nodules refer to abnormal solid nodules growing in normal tissues and organs of the body, which have a higher density and are more uniform than normal lung tissues, while it has been confirmed that STAS can metastasize through solid cancer nests [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], so partial solid nodules and solid nodules are associated with a higher risk of STAS compared with ground-glass nodules. The clinical stage takes into account the patient's overall condition and the tumor's malignancy by measuring factors such as the size, extent, depth of invasion of the primary lesion, metastasis of distant and regional lymph nodes, distant metastasis, and involvement of adjacent organs, with a higher clinical stage indicating a more serious condition [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Perineural invasion, also known as nerve invasion, refers to the encasement of the nerve surface by tumor cells, entering or even within the perineurium, or infiltrating the epineurium, infiltrating into any of the three layers of the nerve sheath, or encasement of the peripheral third of the nerve; lymphatic invasion indicates local occurrence of chronic inflammatory infection; vascular invasion refers to the presence of cancer cells at the vessels, indicating that the tumor cells have metastasized or spread to other tissues before resection; pleural invasion refers to a state of pleural invasion by malignant tumors in the thoracic cavity; A bad prognosis is indicated by the presence of perineural invasion, lymphatic invasion, vascular invasion, or pleural invasion, all of which facilitate the spread and metastasis of cancer cells [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The lobulation sign reflects the dilated growth of the tumor and reflects the different growth rates of cells around the tumor; the bronchial sign is more common in the lung parenchyma; the vascular convergence sign refers to the connection or convergence of large vessels and small trachea with the lesion, which can enter the nodule or concentrate to the nodule once organ lesions occur; and STAS is the dissemination of cancer cells into the lung parenchyma around the tumor by alveolar and bronchiolar channels [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition to the aforementioned, patients with lung adenocarcinoma should pay close attention to the tumor's size, the type of nodules present, the patient's clinical stage, the presence of perineural invasion, lymphatic invasion, vascular invasion, pleural invasion, and CT signs, and certain preventative measures have been implemented to reduce the risk of STAS.\u003c/p\u003e \u003cp\u003eIn their review of the literature, Qu et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] noted that STAS is a significant predictor for poor prognosis and an independent risk factor for tumour recurrence following surgery for lung cancer. in this study, compared with the non-STAS group, the 3-year, 4-year and 5-year survival rates of the STAS group were significantly lower, and primary lung adenocarcinoma associated with STAS was negatively correlated with patient survival, consistent with the results of Qu study, indicating that primary lung adenocarcinoma associated with STAS is closely related to patient prognosis, and the reason was analyzed: STAS can not only interfere with the effect of surgical treatment in patients with early lung cancer, but also predict that the cancer has infiltrated and is more likely to have short-term recurrence [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In order to decrease postoperative recurrence, decrease mortality, and enhance patients' prognoses, it is advised to increase the degree of resection in accordance with the aforementioned clinical guidelines.\u003c/p\u003e \u003cp\u003eThe sample size chosen for this study is too little, and as a result, the data in the results may differ from the actual value. Therefore, additional samples should be gathered later to confirm the study's findings.In conclusion, the prognosis of patients with primary lung adenocarcinoma associated with STAS is strongly correlated with tumour size, nodule type, clinical stage, perineural invasion, lymphatic invasion, vascular invasion, and pleural invasion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no conflicts of interest regarding this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol for this study was approved by the Ethics Committee of\u0026nbsp;The First Affiliated Hospital of Wenzhou Medical University\u0026nbsp;(Approval No. 014562). All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all individual participants involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang QH, Li ML, Yang M, et al. Analysis of immune-related signatures of lung adenocarcinoma identified two distinct subtypes: implications for immune checkpoint blockade therapy [J]. Aging. 2020;12(4):3312\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuan T, Zhang TY, Lv ZH, et al. The lncRNA ALMS1-IT1 may promote malignant progression of lung adenocarcinoma via AVL9-mediated activation of the cyclin-dependent kinase pathway [J]. FEBS Open Bio. 2021;11(5):1504\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin CY, Du L, Nuerlan AH, et al. High expression of RRM2 as an independent predictive factor of poor prognosis in patients with lung adenocarcinoma [J]. Aging. 2020;13(3):3518\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe BX, Song YX, Wang LL, et al. A machine learning-based prediction of the micropapillary/solid growth pattern in invasive lung adenocarcinoma with radiomics [J]. Transl Lung Cancer Res. 2021;10(2):955\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen YX, Jiang CS, Kang WY, et al. Development and validation of a CT-based nomogram to predict spread through air space (STAS) in peripheral stage IA lung adenocarcinoma [J]. Jpn J Radiol. 2022;40(6):586\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassi M, Russomando A, Vannucci J, et al. Role of radiomics in predicting lung cancer spread through air spaces in a heterogeneous dataset [J]. Transl Lung Cancer Res. 2022;11(4):560\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen DL, She YL, Wang TT, et al. Radiomics-based prediction for tumour spread through air spaces in stage I lung adenocarcinoma using machine learning [J]. Eur J Cardiothorac Surg. 2020;58(1):51\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang CS, Luo Y, Yuan JL, et al. CT-based radiomics and machine learning to predict spread through air space in lung adenocarcinoma [J]. Eur Radiol. 2020;30(7):4050\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng Q, Gao H, Zhang LD, et al. Coexistence of a secondary STRN-ALK, EML4-ALK double-fusion variant in a lung adenocarcinoma patient with EGFR mutation: a case report [J]. Anticancer Drugs. 2021;32(8):890\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang C, He ZH, Cheng J, et al. Surgical outcomes of lobectomy versus limited resection for clinical stage I ground-glass opacity lung adenocarcinoma 2 centimeters or smaller [J]. Clin Lung Cancer. 2021;22(2):160\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaghjiani RG, Takahashi Y, Eguchi T, et al. Tumor spread through air spaces is a predictor of occult lymph node metastasis in clinical stage IA lung adenocarcinoma [J]. J Thorac Oncol. 2020;15(5):792\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis [J]. J Thorac Oncol. 2019;14(1):87\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang ZR, Liu Z, Feng HX, et al. Predictive value of radiological features on spread through air space in stage cIA lung adenocarcinoma [J]. J Thorac Dis. 2020;12(11):6494\u0026ndash;504.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong YF, Xu Y, Deng JJ, et al. Prognostic impact of tumour spread through air space in radiological subsolid and pure solid lung adenocarcinoma [J]. Eur J Cardiothorac Surg. 2021;59(3):624\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi CJ, Jiang CS, Gong JS, et al. A CT-based logistic regression model to predict spread through air space in lung adenocarcinoma [J]. Quant Imaging Med Surg. 2020;10(10):1984\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakahashi Y, Kuroda H, Oya Y, et al. Challenges for real-time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection [J]. Thorac Cancer. 2019;10(8):1663\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong TN, Jiang LL, Zhuo ZG, et al. Impacts of thoracoscopic surgery and high grade histologic subtypes on spread through air spaces in small stage I lung adenocarcinomas [J]. J Cancer Res Clin Oncol. 2019;145(9):2375\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQian L, Zhang JG, Lu SM, et al. Potential key roles of tumour budding: a representative malignant pathological feature of non-small cell lung cancer and a sensitive indicator of prognosis [J]. BMJ Open. 2022;12(3):e054009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi JL, Wang Y, Li J, et al. Meta-analysis of lobectomy and sublobar resection for stage I non-small cell lung cancer with spread through air spaces [J]. Clin Lung Cancer. 2022;23(3):208\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa Y, Zhang YY, Li HR, et al. Spread through air spaces is a common phenomenon of pulmonary metastasized tumours regardless of origins [J]. Eur J Cardiothorac Surg. 2022;61(6):1242\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung W, Chung JH, Yum S, et al. The differential prognostic impact of spread through air spaces in early-stage lung adenocarcinoma after lobectomy according to the pT descriptor [J]. J Thorac Cardiovasc Surg. 2022;163(1):277\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuroda H, Masago K, Takahashi Y, et al. Positive correlation between the number of circulating tumor cells in the pulmonary vein and tumor spread through air spaces in resected non-small cell lung cancer [J]. Anticancer Res. 2021;41(11):5499\u0026ndash;505.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQu GD, Shi YF. Progress on the study of tumor spread through air spaces in the clinicopathological characteristics of lung adenocarcinoma and its influence on the surgical treatment and prognosis of lung cancer [J]. Zhongguo Fei Ai Za Zhi. 2019;22(6):363\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerada Y, Takahashi T, Morita S, et al. Spread through air spaces is an independent predictor of recurrence in stage III (N2) lung adenocarcinoma [J]. Interact Cardiovasc Thorac Surg. 2019;29(3):442\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang LL, Tang L, Dai LY, et al. The prognostic significance of tumor spread through air space in stage I lung adenocarcinoma [J]. Thorac Cancer. 2022;13(7):997\u0026ndash;1005.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Primary lung adenocarcinoma, Spread through air space, Clinical characteristics, Related factors, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-8363209/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8363209/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To research the clinical traits and associated elements of primary lung adenocarcinoma with air space dissemination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e To conduct this study, we looked back at the medical records of 200 patients who had primary lung adenocarcinoma and had surgery at our institution between January 2015 and October 2017. Based on whether or not there was concurrent dispersion via air space, they were separated into the non STAS group (153 instances) and the STAS group (47 cases) (STAS). Univariate and multivariate unconditional logistic regression analyses were performed on the obtained patient data to determine the clinical features and relevant variables of STAS in relation to primary lung cancer; Rates of survival were compared between the two groups; STAS was correlated with survival time for those with primary lung adenocarcinoma using the Pearson correlation coefficient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Compared with the non STAS group, the proportion of tumor diameter \u0026gt; 3cm, part of solid nodules, solid nodules, clinical stage Ⅲ~Ⅳ, perineural invasion, lymphatic vessel invasion, vascular invasion, pleural invasion, lobulation sign, bronchial sign and vascular cluster sign in the STAS group increased significantly (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05); Independent risk variables for STAS-related primary lung adenocarcinoma were tumour size, tumour nodule type, clinical stage, perineural invasion, lymphatic vessel invasion, vascular invasion, and pleural invasion (P \u0026lt; 0.05); Survival rates at 3, 4, and 5 years were substantially lower (P \u0026lt; 0.05) for those with STAS compared to those without STAS (82.98 percent, 70.21 percent, and 68.09 percent, respectively). There was a significant inverse correlation between STAS and survival time in patients with primary lung adenocarcinoma (r=-0.423, P = 0.007).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e STAS associated with primary pulmonary adenocarcinoma mostly occurs in patients with larger tumor diameter, solid nodules, higher clinical stage, perineural infiltration, lymphatic vessel infiltration, vascular invasion, pleural invasion, lobulation sign, bronchial sign, and vascular cluster sign. Many factors contribute to it, and it is directly connected to patients' survival rates, therefore it serves as a valuable benchmark for clinical research and patient care.\u003c/p\u003e","manuscriptTitle":"Analysis of clinical characteristics and related factors of primary pulmonary adenocarcinoma with Spread through air space","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 13:12:01","doi":"10.21203/rs.3.rs-8363209/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3fe113db-903e-4d01-9ace-3f170716b630","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-05T07:39:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-05 13:12:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8363209","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8363209","identity":"rs-8363209","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}