Non-small Cell Lung Cancer Staging Accuracy Tied to Nodal Examination

HealthDay News — The prognostic value of pathologic nodal (pN) stratification depends on the thoroughness of nodal examination in the staging of non-small-cell lung cancer, according to a study published online in JAMA Oncology.

Matthew P. Smeltzer, PhD, from the University of Memphis in Tennessee, and colleagues used data from 2047 consecutive patients (51.1% male) who underwent surgical resection from January 1, 2009, through January 25, 2016 at 11 hospitals with annual lung cancer resection volumes of at least 5. Eight sequentially more stringent pN staging quality strata were used.

The researchers found that sequential improvement in the N category-stratified 5-year survival of pN0 and pN1 tumors was found from the least stringent group (0.63 for pN0 vs 0.46 for pN1) to the most stringent group (0.71 for pN0 vs 0.6 for pN1). The pN1 cohorts with 3 or more mediastinal nodal stations examined had the most striking survival improvements. For patients with pN1 and pN2 tumors, more stringently defined mediastinal nodal examination was associated with better separation in survival curves.

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“The prognostic value of pN stratification depends on the thoroughness of examination. Differences in thoroughness of nodal staging may explain a large proportion of intercontinental survival differences,” the authors concluded.

Disclosures: One author disclosed financial ties to the pharmaceutical industry as well as a patent application for a surgical specimen collection kit.


Smeltzer MP, Faris NR, Ray MA, et al. Association of pathologic nodal staging quality with survival among patients with non-small cell lung cancer after resection with curative intent [published online September 28, 2017]. JAMA Oncol. doi:10.1001/jamaoncol.2017.2993