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Optimizing Pre-Operative Clinical Staging in Resectable Non-Small Cell Lung Cancer (NSCLC): A Retrospective Cohort

E Samuel1,2, C Thomas3, C Thompson4

  • 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Thoracic Cancer
|June 16, 2025
PubMed
Summary
This summary is machine-generated.

Accurate staging is crucial for non-small cell lung cancer (NSCLC) treatment. Many patients have discrepancies between clinical and pathological staging, with nodal stage discordance impacting survival and necessitating improved pre-operative assessment.

Keywords:
NSCLCdiscordancemigrationquality indicatorsrisk predictionstage concordance

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Area of Science:

  • Oncology
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Accurate pre-operative clinical staging is vital for guiding treatment decisions in resectable non-small cell lung cancer (NSCLC).
  • Discrepancies between clinical and pathological staging can lead to inappropriate treatment selection.
  • This study investigates staging accuracy, discordance predictors, and survival outcomes in NSCLC patients.

Purpose of the Study:

  • To assess the concordance rate between clinical and pathological staging in resectable NSCLC.
  • To identify factors predicting clinical-pathological staging discordance.
  • To evaluate the impact of staging discrepancies on patient survival.

Main Methods:

  • Retrospective cohort study of Stage I-IIIA NSCLC patients undergoing surgical resection (2011-2020).
  • Clinical staging based on CT, PET, and nodal evaluation; pathological staging based on surgical histology.
  • Multivariable logistic and Cox regression models used to analyze predictors of discordance and survival.

Main Results:

  • 58% of 221 patients had concordant clinical and pathological staging; 42% showed discordance (23.9% upstaged, 17.2% downstaged).
  • N-stage concordance was associated with female sex, tumor histology, SUVmax, and CT-to-surgery interval.
  • Nodal stage discordance independently predicted worse survival (HR 0.43, p=0.01).

Conclusions:

  • Significant discrepancies exist between clinical and pathological staging in resectable NSCLC.
  • Nodal stage discordance is a key predictor of mortality in NSCLC patients.
  • Improved pre-operative staging strategies are needed to ensure guideline-concordant care and optimize patient outcomes.