Objective To investigate the CT features and anatomic basis of peritoneal and retroperitoneal spread of primary acute duodenal inflammation. Methods Twenty-six cases of peritoneal and retroperitoneal spreading acute duodenum inflammation confirmed by gastroscopy and clinical diagnosis during January 2010 to December 2014 were collected. Then we analyzed the CT manifestations of their inflammatory features, and abdominal cavity and retroperitoneal diffusion rules. Results According to the inflammation location, in the 26 cases, there were 1 case of inflammation in the descending part of duodenum, 1 in the horizontal part of duodenum, 15 in both the descending and horizontal parts of duodenum, 7 in both the horizontal and ascending parts of duodenum, and 2 in all the descending, horizontal and ascending parts of duodenum. According to the peritoneal and retroperitoneal spreading locations of acute duodenum inflammation, there were 20 cases of transverse mesocolon and mesenteric root swelling, 17 cases of enlargement of the head of pancreas, 6 cases of ascending colon and ileocecal swelling, 5 cases of anterior and posterior renal fascia of right kidney and perinephric fascia of right kidney swelling, 3 cases of effusion between the anterior and posterior renal fascia and lateral cone fascia of right kidney, 1 case of transverse mesocolon, mesenteric root, and the right pelvic swelling, and 1 cases of abdominal pelvic effusion. Conclusions Acute duodenum inflammation is mainly located in the descending and horizontal parts of duodenum. Different duodenal segments have different degrees of inflammation, while the horizontal segment is the most obvious. Inflammation involving two segments and above can be combined with ulcers. The inflammation infiltrates through transverse mesocolon, mesenteric root, anterior and posterior renal fascia of the right kidney, and spreads to the abdominal and retroperitoneal space, which causes the ascending colon and ileocecal swelling. The effusion can be observed in retroperitoneal space, anterior and posterior renal fascia and abdominal cavity.
It was a short time from the initial investigation of tumor islands to the concept of tumor spread through air spaces (STAS) being adopted as a pattern of invasion in lung adenocarcinoma. Generally, STAS was defined as "spread of lung cancer cells into air spaces in the lung parenchyma beyond the edge of the main tumor". More and more studies had demonstrated that STAS could increase recurrence rate and cause worse prognosis in lung adenocarcinoma. However, criteria of this definition were various in previous studies, and there is no unified criterion of STAS up to now. In addition, perioperative manipulations including specimen processing and surgery procedure could squeeze tumor cells into alveolar spaces which could affect the assessment of STAS. Obviously, we need a precise definition to reduce and quantify the impacts of confounding factors. We summarize recent developments and put forward some advice for further studies in this article.
ObjectiveTo assess the specific clinicopathological characteristics as well as prognostic value of prognostic significance of spread through air spaces (STAS) in lung adenocarcinoma.MethodsWe systematically searched the databases of PubMed, EMbase and Web of Science databases from their date of inception to March 2019. The quality of the included literature was assessed by the Newcastle-Ottawa scale (NOS). The NOS of the study higher than 6 points was considered as high quality. Software of Stata 12.0 was used for meta-analysis.ResultsTwenty retrospective cohort studies involved with totally 6 225 patients were included. Quality of included studies was high with NOS score equal or higher than 6 points. STAS was associated with male sex, ever smoking history, abnormal carcino-embryonic antigen (CEA) level, air bronchogram negative, anaplasticlymphoma kinase (ALK) arrangement positive, epidermal growth factor receptor (EGFR) mutation positive, advanced pathological tumor stage and more invasive pathological adenocarcinoma subtypes. The presence of STAS indicated significantly poor recurrence free survival (RFS) (HR=1.960, 95%CI 1.718-2.237, P<0.001) as well as poor overall survival (OS) (HR=1.891, 95%CI 1.389-2.574, P<0.001). Further subgroup analyses showed that exhibiting tumor size including diameter less than 2 cm (HR=2.344, 95%CI 1.703-3.225, P<0.001) and diameter over 2 cm (HR=2.571, 95%CI 1.559-4.238, P<0.001), resection type including lobectomy (HR=1.636, 95%CI 1.258-2.127, P<0.001) and sublobar resection (HR=3.549, 95%CI 2.092-6.021, P<0.001) in stageⅠ adenocarcinoma suggested that STAS had a bad effect on RFS.ConclusionPresence of STAS is associated with more aggressive clinicopathological features and independently associated with worse RFS and OS in lung adenocarcinoma. STAS positive has a negative effect on RFS whatever the tumor size (including the diameter<2 cm or >2 cm) and resection types in stageⅠ adenocarcinoma.
ObjectiveTo explore the potential role of tumor spread through air spaces (STAS) as a prognostic indicator of non-small cell lung cancer (NSCLC) through meta-analysis.MethodsPubMed, EMbase and Web of Science, from inception to February 2022 were searched by computer about the research of the 5-year overall survival (OS) and recurrence free survival (RFS) of NSCLC patients with or without STAS. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of each study.ResultsTotally 13 published articles were included with 4 647 patients, and1 424 (30.6%) patients had STAS. The NOS score of all studies≥6 points. The meta-analysis showed that compared with the NSCLC patients without STAS, those with STAS had a worse prognosis of 5-year RFS, and the combined HR was 1.89 (95%CI 1.61-2.23); they had a shorter 5-year OS, and the combined HR was 2.25 (95%CI 1.79-2.84). There was no statistical heterogeneity among studies.ConclusionThe presence of STAS may be a poor prognostic factor for patients with NSCLC, and enough attention should be paid. The STAS should be recorded in the pathological report to guide the comprehensive treatment and evaluate the prognosis of patients.