van den Heuvel Guus R M, Mandos Bas L R, Schuurbiers Olga C J, Ciompi Francesco, Aarntzen Erik, Azijli Kaamar, Walraven Iris, Smit Hans J M, van den Heuvel Michel M
Department of Pulmonology, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Computational Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.
Transl Lung Cancer Res. 2025 May 30;14(5):1543-1557. doi: 10.21037/tlcr-2024-1120. Epub 2025 May 22.
Achieving preoperative pathological confirmation and accurate clinical staging are crucial for neoadjuvant treatment decisions in resectable non-small cell lung cancer (NSCLC), though often challenging. This study examines the prevalence of missing preoperative pathological confirmation with focus on patients with clinical stage II or III NSCLC. In addition, pre- and postoperative staging discrepancies are studied in the presence of preoperative NSCLC confirmation. These two impeding factors were studied in an era before the introduction of neoadjuvant chemoimmunotherapy in resectable NSCLC.
In this retrospective observational study, patients with resectable NSCLC diagnosed between 2015 and 2019 were selected. The prevalence of absent preoperative confirmation of NSCLC was evaluated. Stage migration was analyzed in the overall population and across two patient cohorts with either a present or absent upfront pathological NSCLC diagnosis. Relevant stage migration was assessed in the cohort with preoperative NSCLC confirmation. Relevant upstaging was defined as migration from clinical stage I to pathological stage IIA-IIIB and relevant downstaging from clinical stage IIA-IIIB to pathological stage I.
In 277 of 809 patients (34.2%), no preoperative pathological NSCLC diagnosis was obtained, including 83 patients with clinical stage II or III disease (30.0% and 10.3% of the total cohort). In 532 of 809 patients (65.8%), preoperative pathological NSCLC confirmation was achieved. In this cohort, relevant stage migration was noticed in 105 patients (19.7% and 13.0% of the total cohort).
In the era before the introduction of neoadjuvant chemoimmunotherapy as standard of care, absent preoperative NSCLC confirmation or inaccurate staging occurred in nearly a quarter of potential candidates for neoadjuvant treatment. These two limiting factors will need to be addressed in order to adequately administer neoadjuvant therapy in patients with resectable NSCLC conform current guidelines.
尽管术前病理确诊和准确的临床分期对于可切除非小细胞肺癌（NSCLC）新辅助治疗决策至关重要，但往往具有挑战性。本研究以临床II期或III期NSCLC患者为重点，调查术前病理确诊缺失的发生率。此外，在术前NSCLC确诊的情况下，研究术前和术后分期差异。这两个阻碍因素是在可切除NSCLC引入新辅助化疗免疫治疗之前的时代进行研究的。
在这项回顾性观察研究中，选取了2015年至2019年期间诊断为可切除NSCLC的患者。评估NSCLC术前确诊缺失的发生率。在总体人群以及有或无术前NSCLC病理诊断的两个患者队列中分析分期迁移情况。在术前NSCLC确诊的队列中评估相关分期迁移。相关上调分期定义为从临床I期迁移至病理IIA-IIIB期，相关下调分期定义为从临床IIA-IIIB期迁移至病理I期。
809例患者中有277例（34.2%）未获得术前NSCLC病理诊断，其中包括83例临床II期或III期疾病患者（分别占总队列的30.0%和10.3%）。809例患者中有532例（65.8%）获得了术前NSCLC病理确诊。在该队列中，105例患者出现相关分期迁移（分别占总队列的19.7%和13.0%）。
在新辅助化疗免疫治疗作为标准治疗方法引入之前的时代，近四分之一的新辅助治疗潜在候选患者存在术前NSCLC确诊缺失或分期不准确的情况。为了按照当前指南对可切除NSCLC患者充分实施新辅助治疗，需要解决这两个限制因素。
