Significance of peripheral blood indicators in predicting tumor spread through air spaces and survival in pathological stage I lung adenocarcinoma

Abstract Objective: Tumor spread through air spaces(STAS) is a poor prognostic factor for early-stage non-small-cell cancers. This investigation sought to determine the correlations of preoperative peripheral blood parameters with STAS and survival outcomes in pathological stage I lung adenocarcinoma (ADC). Methods: We retrospectively reviewed 633 stage I ADC patients who underwent radical surgical resection for the presence of STAS using HE-stained pathological sections. The baseline clinicopathological features, preoperative peripheral blood indexes and follow-up data were analysed. Independent indicators of STAS were identified using multivariate logistic regression. Kaplan‒Meier analyses were used to examine overall survival (OS) and recurrence-free survival (RFS). Multivariate Cox regression analysis wasused to identifyindependent prognostic variables. Results: STAS was discovered in 285 (45.0%) of the 633 patients. STAS positivity was related to gender, smoking status, disease stage, predominant histological pattern, and differentiation. The multivariate logistic regression identified a level of carcinoembryonic antigen (CEA) ≥5 ug/L and absolute monocyte count (AMC) ≥0.38 G/L as an independent predictor of STAS (p=0.005; p=0.013) among the hematological parameters. STAS positivity was an independent poor prognostic factor for RFS and OS in the CEA <5 µg/L subgroup but not in the CEA ≥5 µg/L subgroup (RFS: HR=2.616, 95% CI=1.414-4.839, p=0.002; OS: HR=5.534, 95% CI=1.186-25.816, p=0.029). In STAS-negative patients but not in STAS-positive patients, CEA demonstrated an independent predictive influence for recurrence and death (RFS: HR=6.488, 95% CI=2.475-17.010, p=0.005; OS: HR=19.569, 95% CI=2.487-153.983, p=0.005). Conclusions: Preoperative hematological examination can be prioritised in predicting the presence of STAS, and CEA ≥5 ug/L and AMC ≥ 0.38 G/L were independent risk predictors for STAS in pathological stage I lung adenocarcinoma. Combining preoperative hematological markers with STAS can optimize the prediction of cancer mortality or recurrence following patient subclassification.