Factors predicting spread through air spaces (STAS) preoperative for T1a–b non-small cell lung cancer

Spread through air spaces (STAS) is a critical factor affecting the prognosis of lung cancer patients and has potential to guide surgical decision-making. Clinical trials have shown that lobectomy reduces recurrence risk more effectively than sub lobectomy in STAS-positive patients. However, STAS diagnosis currently relies on postoperative pathology, and there is a lack of accurate preoperative diagnostic methods. Preoperative prediction of STAS status remains an unmet need. We systematically searched 8 databases (Chinese: CBM, CNKI, WanFang Data, VIP; English: PubMed, Cochrane Library, Web of Science, Embase) from January 2015 to December 2023 using both Chinese and English search terms. Chinese terms included “airspace dissemination”, “lung cancer”, “prediction”; English terms included “spread through air spaces”, “STAS”, “prediction”, “Stage IA Lung cancer”, “Lung Neoplasms [Mesh]”. Retrospective comparative studies analyzing preoperative indicators and postoperative STAS pathological results were included. Literature quality was assessed using the Newcastle-Ottawa Scale (NOS), and data were extracted with RevMan 5.4. Meta-analysis was performed using Stata-64 software. A total of 17 studies involving 5053 patients were included, with 1942 STAS-positive (STAS+) and 3111 STAS-negative (STAS-) patients. Quantitative analysis showed that STAS was significantly associated with preoperative spiculation (OR 3.73, 95%CI 2.24–6.21, p < 0.01), lobulation (OR 3.20, 95%CI 2.47–4.15, p < 0.01), pleural indentation (OR 2.14, 95%CI 1.71–2.68, p < 0.01), cavitation (OR 2.06, 95%CI 1.51–2.83, p < 0.01), and consolidation tumor ratio (CTR) (OR 4.87, 95%CI 3.29–7.22, p < 0.01). Preoperative imaging characteristics including spiculation, lobulation, pleural indentation, cavitation, and CTR can effectively predict STAS status in early-stage lung cancer. These indicators provide valuable references for surgeons in selecting appropriate surgical methods for early non-small cell lung cancer patients.