Survival Analysis of Adjuvant Therapy in Stage I STAS-Positive Lung Adenocarcinoma Patients Undergoing Different Surgical Approaches

Background Recent research on spread through air spaces (STAS) has gained prominence. The presence of STAS is not only an independent factor associated with lung cancer recurrence and prognosis, but it remains unclear whether adjuvant therapy (AT) affects survival in STAS-positive stage I lung adenocarcinoma (ADC) patients undergoing different surgical approaches. Methods A retrospective analysis was conducted on patients with pT1-2aN0M0 ADC who underwent complete resection at the Department of Thoracic Surgery, Qingdao University Affiliated Hospital, between 2019 and 2021. Among these, 528 cases with pathologically confirmed STAS were ultimately included. Propensity score matching (PSM) was employed to match patients across different groups. Kaplan-Meier analysis and Cox proportional hazards regression models were employed to evaluate surgical approaches and validate whether AT confers a survival benefit in patients with STAS undergoing different surgical procedures. Results Among stage I ADC patients with STAS, matched patients undergoing sublobar resection versus lobectomy demonstrated a significant difference in recurrence-free survival (RFS) (P = 0.0019) but no significant difference in overall survival (OS) (P = 0.61). Multivariate analysis confirmed these findings. (Lobectomy vs. Sublobar resection, OS: HR = 0.24, 95% CI, 0.10–0.56, P = 0.001; RFS: HR = 0.19, 95% CI, 0.11–0.34, P < 0.001). Patients undergoing sublobar resection achieved superior 5-year RFS following adjuvant therapy (P = 0.0046), with recurrence rates nearly comparable to lobectomy (5.9% vs 8.9%). However, adjuvant therapy did not improve 5-year RFS in patients undergoing lobectomy (P = 0.76). Multivariate analysis results are as follows (adjuvant therapy vs. no adjuvant therapy): OS: HR = 0.18, 95% CI, 0.07–0.49, P = < 0.001; RFS: HR = 0.15, 95% CI 0.07–0.32, P = < 0.001). Conclusion In stage I adenocarcinoma patients with STAS, lobectomy yields superior outcomes compared to sublobar resection. Patients undergoing sublobar resection with pathologically confirmed STAS may benefit from adjuvant therapy.