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.