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Stage-dependent prognostic value of clinical and pathological T staging in resected lung adenocarcinoma: a
Libing Yang1, Chao Guo1, Xin Du1,2
1Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China.
Background:
Preoperative CT-based clinical T staging guides surgical planning in lung adenocarcinoma, whereas pathological T staging remains the postoperative reference standard. Prior studies have demonstrated discordance between clinical and pathological TNM staging in lung cancer, but stage-specific T-stage migration, comparative prognostic value, and implications for surgical decision thresholds in lung adenocarcinoma remain insufficiently defined.
Methods:
This retrospective multicenter cohort study included 10,767 patients with surgically resected invasive lung adenocarcinoma. Clinical tumor size and T stage were obtained from official preoperative CT reports using the maximum reported tumor diameter, whereas pathological tumor size and T stage were obtained from final surgical pathology reports. Concordance, stage migration, and receiver operating characteristic (ROC) performance were assessed across T categories. Survival analyses were performed in 6,279 patients with follow-up data, and C-index was used to compare the prognostic discrimination of clinical versus pathological tumor size.
Results:
CT-based tumor size exceeded pathological measurement on average (mean, 1.83 cm vs. 1.51 cm), with downstaging predominating across cT1c-T3 tumors. Clinical-pathological T-stage agreement followed a stage-dependent pattern, with concordance highest at the extremes (T1a, T4) and lowest at intermediate stages, a finding supported by ROC analysis. Both clinical and pathological T staging stratified disease-free and overall survival. C-index analysis suggested a modest stage-dependent crossover in prognostic discrimination: clinical tumor size showed better discrimination in early-stage disease (cT1a-T1b), whereas pathological tumor size performed better in advanced stages (T3-T4).
Conclusions:
Clinical and pathological T staging provide complementary, context-dependent information across the disease spectrum. Clinical staging showed higher concordance with pathological staging and slightly better prognostic discrimination in early-stage tumors (T1a-T1b), whereas pathological staging offered stronger discrimination in advanced disease. These findings refine the interpretation of T staging in resected invasive lung adenocarcinoma by emphasizing measurement source, disease-stage context, and uncertainty around operative decision thresholds.