Samuel E, Thomas C, Thompson C, Paul E, Cherk M, Ellis S, Siemienowicz M, Tissera S, Samankula U, Scholz S, Zhang L, Grewal J, Cox J, Yu C, Adabi G, Keating D, Taverner J, Gooi J, Wayne S, Zalcberg J, Stirling R G
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Medical Oncology, Latrobe Regional Health, Latrobe City, Victoria, Australia.
Thorac Cancer. 2025 Jun;16(11):e70108. doi: 10.1111/1759-7714.70108.
Accurate pre-operative clinical staging is essential for guiding treatment in resectable non-small cell lung cancer (NSCLC). Discrepancies between clinical and pathological staging raise concerns about treatment appropriateness. This study aimed to assess staging accuracy, identify predictors of discordance, and evaluate survival implications.
We conducted a retrospective cohort study of Stage I-IIIA NSCLC patients who underwent surgical resection in Melbourne, Australia, between 2011 and 2020. Clinical staging was based on CT, PET, and nodal evaluation; pathological staging was based on surgical histology. The primary outcome was concordance between clinical (cTN) and pathological (pTN) stage. Multivariable logistic and Cox regression models evaluated predictors of discordance and survival.
Among 221 patients, 58% had concordant clinical and pathological staging. Discordance occurred in 42% of cases-23.9% were upstaged and 17.2% downstaged. N-stage concordance was associated with female sex, tumor histology, SUV max, and CT-to-surgery interval. Nodal discordance independently predicted worse survival (HR 0.43, 95% CI: 0.24-0.77; p = 0.01).
Substantial discrepancies exist between clinical and pathological staging in resectable NSCLC. Nodal stage discordance is an independent predictor of mortality and highlights the need for improved pre-operative staging strategies to ensure guideline-concordant care.
准确的术前临床分期对于指导可切除非小细胞肺癌（NSCLC）的治疗至关重要。临床分期与病理分期之间的差异引发了对治疗适当性的担忧。本研究旨在评估分期准确性，确定不一致的预测因素，并评估生存影响。
我们对2011年至2020年在澳大利亚墨尔本接受手术切除的I-IIIA期NSCLC患者进行了一项回顾性队列研究。临床分期基于CT、PET和淋巴结评估；病理分期基于手术组织学。主要结局是临床（cTN）和病理（pTN）分期之间的一致性。多变量逻辑回归和Cox回归模型评估不一致的预测因素和生存率。
在221例患者中，58%的患者临床和病理分期一致。42%的病例出现分期不一致，其中23.9%分期上调，17.2%分期下调。N分期的一致性与女性、肿瘤组织学、SUV最大值和CT至手术间隔有关。淋巴结分期不一致独立预测较差的生存率（HR 0.43，95%CI：0.24-0.77；p = 0.01）。
可切除NSCLC的临床分期与病理分期之间存在显著差异。淋巴结分期不一致是死亡率的独立预测因素，凸显了改进术前分期策略以确保符合指南治疗的必要性。
