Pathologic Nodal Staging Quality and Survival Differences in Non–Small Cell Lung Cancer
Matthew P. Smeltzer, PhD, of the University of Memphis, and colleagues found that intercontinental survival differences may be linked to how well pathologic nodal (pN) staging is done in non–small cell lung cancer (NSCLC). Writing in JAMA Oncology, the authors concluded, "The prognostic value of pN stratification depends on the thoroughness of examination.”
This observational study focused on a population-based database of 2047 consecutive patients. The investigators wanted to determine whether survival was affected by sequentially more stringent definitions of pN staging quality in patients with NSCLC after resection.
Sequential improvement in the N category–stratified 5-year survival of pN0 and pN1 tumors was demonstrated from the least stringent group to the most stringent group. The most “striking” survival improvements were found in the pN1 cohorts with three or more mediastinal nodal stations examined. More stringently defined nodal examination was linked to better separation in survival curves for patients with pN1 and pN2 tumors.
To improve the prognostic value of the TNM staging system, Dr. Smeltzer and colleagues suggested that future updates should include more quality restraints for nodal examination.