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The following is a summary of “Benefit of adjuvant chemotherapy for resected stage I lung cancer with spread through air spaces: a systematic review and meta-analysis,” published in the April 2025 issue of the European Journal of Surgical Oncology by Du et al.

Spread through air spaces (STAS) has been recognized as an independent predictor of poor prognosis in patients with stage I lung cancer. However, the clinical role of adjuvant chemotherapy (ACT) in improving outcomes among patients who are STAS-positive remains inadequately defined. This meta-analysis was conducted to clarify the impact and clinical indications for ACT in this specific patient population.

A systematic search of three major electronic databases was performed to identify relevant studies published up to June 26, 2024. Studies meeting predefined inclusion and exclusion criteria were selected for analysis. The primary outcomes assessed were DFS and OS, with HRs and 95% CIs calculated. Sensitivity analyses were also conducted to explore potential sources of heterogeneity.

Five studies comprising a total of 2,899 patients with stage I lung cancer were included in the meta-analysis. The pooled analysis demonstrated that ACT was associated with significant improvements in both DFS (HR 0.69; 95% CI, 0.48–0.99; P = 0.044) and OS (HR 0.61; 95% CI, 0.47–0.79; P < 0.001) among patients who are STAS-positive. Importantly, even among those who underwent lobectomy, ACT provided a survival advantage, with notable benefits observed in both DFS (HR 0.61; 95% CI, 0.45–0.82; P = 0.001) and OS (HR 0.60; 95% CI, 0.42–0.85; P = 0.005).

Further subgroup analysis revealed that the benefit of ACT was more pronounced in patients with stage IB disease. In this subgroup, ACT significantly prolonged DFS (HR 0.55; 95% CI, 0.38–0.79; P = 0.001). Conversely, in patients with stage IA disease, the improvement in DFS associated with ACT did not reach statistical significance (HR 0.72; 95% CI, 0.42–1.25; P = 0.246).

In conclusion, the findings suggest that ACT may offer a meaningful survival benefit for STAS-positive patients with stage IB lung cancer, even after complete surgical resection via lobectomy. While these results provide valuable insights for clinical decision-making, randomized controlled trials (RCTs) are necessary to validate these findings and to establish definitive treatment guidelines for this high-risk subgroup.

Source: ejso.com/article/S0748-7983(25)00532-3/fulltext