Banks Kian C, Sarovar Varada, Sun Angela, Wile Rachel K, Barnes Katherine E, Velotta Jeffrey B
Division of General Surgery, Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA.
Ann Surg Oncol. 2025 Jun;32(6):4151-4160. doi: 10.1245/s10434-025-17034-0. Epub 2025 Feb 20.
Preoperative invasive nodal staging is standard of care for early-stage non-small cell lung cancer (NSCLC). Complications and delays in care are not negligible and diagnostic accuracy varies. In our system, invasive nodal staging is performed for clear radiographic indications (node > 1.0 cm short axis or standardized uptake value > 3.0, tumor > 4.0 cm). This study assessed whether unexpected mediastinal upstaging was less common in patients receiving preoperative invasive nodal staging.
This retrospective study evaluated nodal upstaging, defined as pathological N2 or IIIA+ disease, based on receipt or non-receipt of invasive nodal staging. Clinical stage I-II NSCLC patients who underwent resection (2009-2019) were identified from our cancer registry. Stage and preoperative nodal staging information were confirmed through chart review. Associations between patient characteristics, invasive nodal staging receipt, and clinical to pathological stage changes were analyzed.
Among 2576 patients, 18.7% (n = 481) underwent invasive nodal staging. After resection, 6.2% of all patients had nodal upstaging and 24.9% had TNM upstaging. Only 0.3% (n = 9) were upstaged to N2 and 0.5% (n = 13) were upstaged to IIIA+. Lack of preoperative nodal sampling was not associated with N2 or IIIA+ upstaging. Findings were consistent in subanalyses of patients with surgical specimens meeting Commission on Cancer nodal sampling criteria and with clinical IB+ disease.
Although most patients did not undergo invasive nodal staging, <1% had unexpected N2 on surgical pathology. There was no association between lack of preoperative invasive nodal sampling and N2 nodal upstaging. Preoperative invasive nodal staging did not increase pathologic N2 nodal upstaging in early-stage NSCLC patients in our integrated health system.
术前有创淋巴结分期是早期非小细胞肺癌（NSCLC）的标准治疗方法。其并发症和护理延误不容忽视，且诊断准确性存在差异。在我们的系统中，对于明确的影像学指征（短轴淋巴结>1.0 cm或标准化摄取值>3.0，肿瘤>4.0 cm）进行有创淋巴结分期。本研究评估了接受术前有创淋巴结分期的患者中意外纵隔分期上调的情况是否较少见。
这项回顾性研究根据是否接受有创淋巴结分期评估了定义为病理N2或IIIA+期疾病的淋巴结分期上调情况。从我们的癌症登记处识别出2009年至2019年接受手术的临床I-II期NSCLC患者。通过病历审查确认分期和术前淋巴结分期信息。分析了患者特征、有创淋巴结分期接受情况与临床分期至病理分期变化之间的关联。
在2576例患者中，18.7%（n = 481）接受了有创淋巴结分期。切除术后，所有患者中有6.2%出现淋巴结分期上调，24.9%出现TNM分期上调。仅0.3%（n = 9）上调至N2期，0.5%（n = 13）上调至IIIA+期。术前未进行淋巴结采样与N2或IIIA+期上调无关。在符合癌症委员会淋巴结采样标准的手术标本患者和临床IB+期疾病患者的亚分析中，结果一致。
尽管大多数患者未接受有创淋巴结分期，但手术病理中意外出现N2期的患者不到1%。术前未进行有创淋巴结采样与N2期淋巴结分期上调之间无关联。在我们的综合医疗系统中，术前有创淋巴结分期并未增加早期NSCLC患者的病理N2期淋巴结分期上调。
