JTO Clinical and Research Reports (Aug 2024)

What Is the Accuracy of Clinical Staging for Stage III-Single-station N2 NSCLC? A Multi-Centre UK Study

  • Christopher Craig, MBChB,
  • Janet Johnston, M.B.B.S.,
  • Patrick Goodley, MB BChir,
  • Paul Bishop, BA, MB BCh, FRCPath,
  • Haider Al-Najjar, MBChB, FRCP,
  • Louise Brown, MD, MRCP,
  • Joanna Gallagher, MBChB,
  • Ramachandran Sundar, M.B.B.S.,
  • Sara Upperton, MBChB,
  • Matthew Callister, BM BCh,
  • David Meek, BM, MRCP SCE,
  • Laura Succony, BM,
  • Wadood Parvez, M.B.B.S.,
  • Muhammad Tufail, M.B.B.S., FRCP,
  • Geeshath Jayasekera, MBChB, MRCP, PhD,
  • John Maclay, MBChB,
  • Alana Livesey, MB BChir,
  • Ian Woolhouse, M.B.B.S.,
  • Natalie Smith, BSc, MBChB,
  • Anna Bibby, MBChB, PhD,
  • Matthew Evison, MD, MRCP, MBChB

Journal volume & issue
Vol. 5, no. 8
p. 100694

Abstract

Read online

Introduction: Single-station N2 (ssN2) versus multi-station N2 has been used as a selection criterion for treatment recommendations between surgical versus non-surgical multimodality treatment in stage III-N2 NSCLC. We hypothesized that clinical staging would be susceptible to upstaging on pathologic staging and, therefore, challenge this practice. Methods: A retrospective study of prospectively collected routine clinical data for patients with stage III-N2 NSCLC that had completed computed tomography (CT), positron emission tomography (PET), and staging endobronchial ultrasound (EBUS) and had been confirmed clinical stage III-ssN2 at multidisciplinary team discussion and went on to complete surgical resection as the first treatment to provide pathologic staging. The study was completed in two cohorts (A) across a single cancer alliance in England (Greater Manchester) January 1, 2015 to December 31, 2018 and (B) across five United Kingdom centers to validate the findings in part A January 1, 2016 to December 31, 2020. Results: A total of 115 patients met the inclusion criteria across cohort A (56 patients) and cohort B (59 patients) across 15 United Kingdom hospitals. The proportion of cases in which clinical stage III-ssN2 was upstaged to pathologic stage III-multi-station N2 was 34% (19 of 56) in cohort A, 32% in cohort B (19 of 59), and 33% across the combined study cohort (38 of 115). Most patients had a single radiologically abnormal lymph node on CT and PET (88%, 105 of 115). In the majority, the reasons for missed N2 disease on staging EBUS were due to inaccessible (stations 5, 6, 8, 9) N2 nodes at EBUS (34%, 13 of 38) and accessible lymph nodes not sampled during staging EBUS as not meeting sampling threshold (40%, 15 of 38) rather than false-negative sampling during EBUS (26%, 10 of 38). Conclusions: During multidisciplinary team discussions, clinicians must be aware that one-third of patients with stage III-ssN2 on the basis of CT, PET, and staging EBUS do not truly have ssN2 and this questions the use of this criterion to define treatment recommendations.

Keywords