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Real-Life Pre-Operative Nodal Staging Accuracy in Non-Small Cell Lung Cancer and Its Relationship with Survival
Ahmed Alkarn1,2, Liam J Stapleton1, Dimitra Eleftheriou3
1Glasgow Royal Infirmary, Glasgow G4 0SF, UK.
Diagnostics (Basel, Switzerland)
|February 26, 2025
Summary
Accurate staging of non-small cell lung cancer (NSCLC) is crucial. Under-staging NSCLC pre-operatively independently predicts increased mortality, highlighting the importance of precise mediastinal nodal staging for patient survival.
Area of Science:
- Oncology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Accurate staging of non-small cell lung cancer (NSCLC) is essential for treatment planning and prognosis.
- Mediastinal nodal staging accuracy significantly impacts patient outcomes.
Purpose of the Study:
- To evaluate agreement between pre-operative and post-operative mediastinal nodal staging in NSCLC.
- To determine the impact of staging discrepancies on 2-year lung cancer-specific survival.
Main Methods:
- Retrospective multi-center cohort study of 973 NSCLC patients undergoing surgical resection (2015-2017).
- Analysis of pre-operative staging from multidisciplinary team (MDT) meetings versus post-surgical pathological staging.
- Regression analysis to identify associations between staging disparities and 2-year mortality.
Main Results:
- 80% concordance between pre- and post-operative nodal staging.
- 13% of patients were under-staged, and 7% were over-staged pre-operatively.
- Pre-operative under-staging was independently associated with increased 2-year lung cancer-specific mortality.
Conclusions:
- Invasive mediastinal staging, particularly using endobronchial ultrasound (EBUS), improves pre-operative staging accuracy.
- Pre-operative nodal under-staging in NSCLC is a significant predictor of poorer survival.
- Accurate nodal staging is fundamental for optimal NSCLC management and improved patient outcomes.
