Optimizing Pre-Operative Clinical Staging in Resectable Non-Small Cell Lung Cancer (NSCLC): A Retrospective Cohort Study.

IF 2.3 3区医学 Q3 ONCOLOGY

Thoracic Cancer Pub Date : 2025-06-01 DOI:10.1111/1759-7714.70108

E Samuel, C Thomas, C Thompson, E Paul, M Cherk, S Ellis, M Siemienowicz, S Tissera, U Samankula, S Scholz, L Zhang, J Grewal, J Cox, C Yu, G Adabi, D Keating, J Taverner, J Gooi, S Wayne, J Zalcberg, R G Stirling

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Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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优化可切除非小细胞肺癌（NSCLC）的术前临床分期：一项回顾性队列研究。

背景：准确的术前临床分期对于指导可切除的非小细胞肺癌（NSCLC）的治疗至关重要。临床和病理分期之间的差异引起了对治疗适当性的关注。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。方法：我们对2011年至2020年间在澳大利亚墨尔本接受手术切除的I-IIIA期非小细胞肺癌患者进行了回顾性队列研究。临床分期基于CT、PET和淋巴结评估；病理分期以手术组织学为依据。主要结局是临床（cTN）和病理（pTN）分期的一致性。多变量logistic和Cox回归模型评估了不一致性和生存率的预测因子。结果：221例患者中，58%的患者临床和病理分期一致。42%的病例出现了不一致，其中23.9%为上戏，17.2%为下戏。n期一致性与女性性别、肿瘤组织学、SUV max和ct至手术时间间隔有关。淋巴结不一致独立预测较差的生存(HR 0.43, 95% CI: 0.24-0.77；p = 0.01)。结论：可切除的非小细胞肺癌的临床分期与病理分期存在显著差异。淋巴结分期不一致是死亡率的一个独立预测指标，并强调需要改进术前分期策略，以确保指导一致的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thoracic Cancer ONCOLOGY-RESPIRATORY SYSTEM

CiteScore

5.20

自引率

3.40%

发文量

439

审稿时长

2 months

期刊介绍： Thoracic Cancer aims to facilitate international collaboration and exchange of comprehensive and cutting-edge information on basic, translational, and applied clinical research in lung cancer, esophageal cancer, mediastinal cancer, breast cancer and other thoracic malignancies. Prevention, treatment and research relevant to Asia-Pacific is a focus area, but submissions from all regions are welcomed. The editors encourage contributions relevant to prevention, general thoracic surgery, medical oncology, radiology, radiation medicine, pathology, basic cancer research, as well as epidemiological and translational studies in thoracic cancer. Thoracic Cancer is the official publication of the Chinese Society of Lung Cancer, International Chinese Society of Thoracic Surgery and is endorsed by the Korean Association for the Study of Lung Cancer and the Hong Kong Cancer Therapy Society. The Journal publishes a range of article types including: Editorials, Invited Reviews, Mini Reviews, Original Articles, Clinical Guidelines, Technological Notes, Imaging in thoracic cancer, Meeting Reports, Case Reports, Letters to the Editor, Commentaries, and Brief Reports.