肿瘤空气扩散（STAS）是肺癌转移的一种独特机制，然而，它在I期肺腺癌（ADC）中的临床价值目前仍不明确。我们调查了（1）肺腺癌I期患者亚叶切除与肺叶切除后的预后比较，以及伴随化疗（ACT）对I期ADC与STAS的患者的（2）潜在益处。在我们的机构中，在2014年至2018年之间回顾性识别了3328例连续的I期ADC患者；其中，600例被诊断为STAS。使用Kaplan-Meier分析和Cox比例危险回归模型评估了STAS对总体生存率（OS）和无复发生存率（RFS）的影响。在具有STAS的IA期患者中，亚叶切除和肺叶切除的OS （P = 0.919）和RFS （P = 0.066）之间没有显着差异。多元分析证实了此结果（亚叶切除与肺叶切除，OS：HR = 0.523，95％CI，0.056-18.458，P = 0.714；RFS：HR = 0.360，95％CI，0.115-1.565，P = 0.897）。ACT不会改善I期患者的预后，但可以改善高复发风险因素的IB期患者的RFS，包括恶性肿瘤、淋巴血管侵犯和内脏胸膜侵犯（P = 0.046）。亚叶切除和肺叶切除对具有STAS的IA期ADC患者提供了相似的预后。当STAS术后被确认时，应考虑为具有高复发风险因素的IB期患者提供ACT治疗，但不适用于具有IA期的患者。版权所有©2023年作者。Elsevier B.V.出版。保留所有权利。

Tumor spread through air spaces (STAS) is a unique mechanism of lung cancer metastasis; however, its clinical value for stage I lung adenocarcinoma (ADC) remains unclear at present. We investigated the (1) prognosis of patients after sublobar resection compared with lobectomy for stage I lung adenocarcinoma with STAS; and (2) potential benefits of adjuvant chemotherapy (ACT) for patients with stage I ADC and STAS.A total of 3328 consecutive patients with stage I ADC were retrospectively identified between 2014 and 2018 at our institution; among them, 600 were diagnosed with STAS. Kaplan-Meier analysis and Cox proportional hazard regression models were used to evaluate the impact of STAS on overall survival (OS) and recurrence-free survival (RFS).Among stage IA patients with STAS, there was no significant difference between those who underwent sublobar resection and lobectomy in OS (P = 0.919) and RFS (P = 0.066). Multivariate analysis confirmed this result (sublobar resection versus lobectomy, OS: HR = 0.523, 95 % CI, 0.056-18.458, P = 0.714; RFS, HR = 0.360, 95 % CI, 0.115-1.565, P = 0.897). ACT did not improve the prognosis of stage IA patients but did improve the RFS of stage IB patients with high-risk recurrence factors, including poorly differentiated tumors, lymphovascular invasion and visceral pleural invasion (P = 0.046).Sublobar and lobectomy resection provided a comparable prognosis for stage IA ADC patients with STAS. When STAS was confirmed postoperatively, ACT should be considered for patients with stage IB with high-risk recurrence factors but not for those with stage IA disease.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.