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Alkarn, Ahmed and Stapleton, Liam J. and Eleftheriou, Dimitra and Stewart, Laura and Chalmers, George and Hamed, Ahmad and Hussein, Khaled and Blyth, Kevin G. and van der Hors, Joris C. and Maclay, John D. (2025) Real life pre-operative nodal staging accuracy in non-small cell lung cancer and its relationship with survival. Diagnostics, 15 (4): 430. ISSN 2075-4418

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A retrospective cohort study of 973 patients with non-small cell lung cancer (NSCLC) found that pre-operative nodal under-staging was associated with increased lung cancer-specific mortality. Invasive mediastinal staging with endobronchial ultrasound (EBUS) was independently associated with more accurate pre-operative staging.

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Abstract

Background/Objectives: The precise staging of non-small cell lung cancer (NSCLC) determines its initial treatment and provides more accurate prognostic information for patients. The aim of this cohort study was to determine pre- and post-operative mediastinal nodal staging agreement and its effect on 2-year survival. Methods: A retrospective multi-centre cohort study was performed, using prospectively collected and pre-defined data from weekly lung cancer multidisciplinary team (MDT) meetings in 11 hospitals. Consecutive patients who underwent surgical resection of NSCLC between 2015 and 2017 were eligible. Pre-operative under-staging was defined as a lower pre-operative than post-operative nodal stage, and pre-operative over-staging as a higher pre-operative than post-operative nodal stage. Disparities between pre-operative nodal staging established at MDT and post-surgical nodal staging were determined and associations with subsequent lung cancer-specific 2-year mortality were identified using univariate and multivariate regression. Results: A total of 973 patients fulfilled the eligibility criteria. Concordant pre- and post-operative nodal staging was observed in 783/973 (80%), 123/973 (13%) were under-staged pre-operatively and 67/973 (7%) were over-staged. In 173 patients with clinical N1 or N2 disease (in whom invasive mediastinal staging was indicated), staging EBUS was performed in 55/173 (32%). In these patients, younger age and use of staging EBUS were independent predictors of concordant pre- and post-operative staging. In all patients, pre-operative under-staging was independently associated with increased lung cancer-specific 2-year mortality. There was no increased mortality associated with pre-operative nodal over-staging. Conclusions: Invasive mediastinal staging with EBUS was independently associated with more accurate pre-operative staging. Pre-operative nodal under-staging was associated with increased lung cancer-specific mortality. Nodal staging accuracy in potentially curable NSCLC is of fundamental importance to ensure patients receive the correct first-line treatment and to improve survival.

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Alkarn, Ahmed

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Stapleton, Liam J.

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Eleftheriou, Dimitra

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Stewart, Laura

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Chalmers, George

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Hamed, Ahmad

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Hussein, Khaled

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Blyth, Kevin

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Neilly, Mark D.J. and Dick, Craig and Blyth, Kevin G. (2025) Non-Specific Pleuritis: an update. Current Pulmonology Reports, 14: 7. ISSN 2199-2428

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