Clinical Versus Pathologic Staging in Early-Stage Non-Small Cell Lung Cancer Assessed by an Established Lung Cancer
James Nolan1,2, Theron Sather1, Craig Hukins1,2
1Respiratory Sleep and Mycobacterial Medicine, The Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Thoracic Cancer
|March 18, 2026
Summary
Clinical under-staging of early-stage non-small cell lung cancer (NSCLC) is linked to treatment delays and specific histopathological features. This under-staging significantly increases patient mortality and disease recurrence risks, highlighting the need for timely care.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Diagnostics
Background:
- Accurate clinical staging is crucial for non-small cell lung cancer (NSCLC) treatment decisions.
- Clinical-pathological staging concordance is a key quality indicator in lung cancer care.
- This study focuses on clinical under-staging in early-stage NSCLC managed by a multidisciplinary team (MDT).
Purpose of the Study:
- To compare clinical and pathological staging in early-stage NSCLC.
- To identify factors contributing to clinical under-staging.
- To assess the impact of clinical under-staging on patient outcomes.
Main Methods:
- Retrospective review of early-stage NSCLC patients undergoing surgical management.
- Data collected from January 2019 to December 2023.
- Analysis of staging concordance, under-staging factors, and patient outcomes.
Main Results:
- 73% overall clinical-pathological staging concordance; 18.9% were clinically under-staged.
- Under-staging associated with delays between imaging and surgery, and visceral pleural, vessel, and lymphatic invasion.
- Clinically under-staged patients had increased mortality (OR 2.06) and recurrence (OR 2.06) risks.
Conclusions:
- Disagreement in staging may stem from treatment delays and tumor characteristics.
- Clinical under-staging elevates morbidity and mortality, emphasizing the need for timely interventions.
- Staging concordance should be a standard benchmark for lung cancer MDTs.
