Preoperative biopsy not linked to tumor spread in stage I non-small cell lung cancer
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A preoperative biopsy procedure did not raise the risk for tumor spread through airspaces among patients with resected stage I non-small cell lung cancer, according to a study published in CHEST.
Further, this procedure was not a significant risk factor for lung cancer recurrence or lung cancer-related death, researchers reported.
“Our results indicated that tumor spread through airspaces (STAS) is a unique feature of tumor invasion unaffected by preoperative mechanical forces that may cause tumor spread,” Ga Young Lee, MD, from the division of pulmonary and critical care medicine at Seoul National University Bundang Hospital, and colleagues wrote. “Thus, physicians can lessen their concerns over the effect of preoperative tumor biopsy on STAS and its prognostic impact.”
STAS — defined as the spread of tumor cells within airspaces in the lung parenchyma beyond the edge of the primary tumor — has been associated with increased recurrence and poorer survival in non-small cell lung cancer (NSCLC). Although older age, smoking, larger tumor size and other tumor characteristics have been associated with STAS, data are lacking on the link between STAS and preoperative diagnostic tumor biopsy, according to the researchers.
In a retrospective cohort study, Lee and colleagues analyzed 2,169 adults (mean age, 64.5 years; 51.1% men; 52.7% never-smokers) who had surgery for pathologic stage I NSCLC from 2011 to 2019 to determine whether a preoperative biopsy procedure — percutaneous needle biopsy (PCNB) or bronchoscopic biopsy — raises the risk for STAS or affects prognosis.
Researchers performed multivariable Cox regression analyses to assess the correlation between preoperative biopsy and STAS-related outcomes, including the recurrence of lung cancer or death due to lung cancer. Researchers included variables such as age, sex, smoking pack-years, preoperative PCNB, bronchoscopic biopsy, sublobar resection and histologic type.
Mean follow-up was 45.7 ± 28 months.
Of the total cohort, 638 patients (29.4%) had STAS, 144 (6.6%) had lung cancer recurrence and 35 died of lung cancer.
Although univariate analysis indicated the risk for STAS was significantly related to preoperative PCNB, bronchoscopic biopsy or both, multivariate analysis demonstrated that these relationships were no longer significant. Rather, the risk for STAS was significantly associated with the radiologically solid type of tumor (OR = 3.07; 95% CI, 2.43-3.87), invasive tumor size (OR = 1.98; 95% CI, 1.75-2.24) and the histologic type of adenocarcinoma (OR = 4.44; 95% CI, 3.09-6.37).
When evaluating cancer recurrence, researchers found that STAS increased this risk with a hazard ratio of 1.72 (95% CI, 1.2-2.48) in an analysis adjusted for preoperative tumor biopsy.
This analysis also showed that sublobar resection in patients with STAS was a significant risk factor for cancer recurrence (HR = 3.2; 95% CI, 1.65-6.21) and lung cancer-specific mortality (HR = 12.71; 95% CI, 3.68-43.92). These associations did not persist among patients without STAS.
All multivariate models showed that preoperative biopsy did not affect lung cancer recurrence or mortality.
“Our findings indicated that preoperative tumor biopsy was not a risk factor for STAS and that it did not influence the associated outcomes,” Lee and colleagues wrote. “Moreover, possible effects of preoperative biopsy on the clinical course of resected lung cancer must be considered independently from STAS.”
This study by Lee and colleagues adds to the literature indicating that preoperative biopsy is not harmful for patients who have undergone surgery for stage I NSCLC, according to an accompanying editorial by Hironori Uruga, MD, PhD, from the department of diagnostic pathology at Toranomon Hospital in Tokyo, and Mari Mino-Kenudson, MD, from the department of pathology at Massachusetts General Hospital and Harvard Medical School.
“In summary, Lee [and colleagues] have successfully shown that preoperative biopsy does not increase the incidence of STAS or STAS-related adverse outcomes in patients with resected stage I non-small cell lung cancer,” Uruga and Mino-Kenudson wrote. “These results are highly informative and may alleviate anxiety over preoperative biopsy possibly generating STAS.”
They added, “Several questions remain, however, regarding biology and clinical management of STAS; thus, further studies are warranted to improve the prognosis of patients with early-stage lung cancer.”