Methods: Between September 2001 and November 2024, a total of 380 patients (279 males, 101 females; mean age: 61.6±10.1 years; range, 20 to 87 years) who were diagnosed with primary lung cancer and underwent surgical resection were retrospectively analyzed. Demographic, clinical, and pathological data of the patients were collected and their association with STAS positivity was evaluated.

Results: A higher preoperative monocyte count was significantly associated with STAS positivity (0.73±0.63 vs. 0.58±0.22; p=0.003; odds ratio=5.57; 95% confidence interval: 1.76-17.6). Pathological N1 and N2 stages, along with increased maximum standardized uptake value (SUVmax) in the lymph nodes, were related to STAS positivity. In the multivariate analysis, only adenocarcinoma histology and elevated monocyte count were found to be independently associated with STAS positivity.

Conclusion: Adenocarcinoma histology and increased preoperative monocyte levels are independent predictors of STAS in patients with non-small cell lung cancer. Elevated SUVmax values in the lymph nodes may indicate a potential association with STAS positivity. These findings may be a guide for preoperative risk stratification and individualized treatment planning in clinical practice.