WCLC 2025 - Posters & ePosters-P1.17.50 Correlation Between Clinical and Pathological Stage in Resected NSCLC

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This study investigates the concordance between clinical (cTNM) and pathological (pTNM) staging in resectable non-small cell lung cancer (NSCLC) patients undergoing upfront surgery, using data from the National Cancer Database (NCDB) spanning 2004–2020. Accurate staging is critical since clinical stage guides neoadjuvant therapy decisions, while pathologic stage influences adjuvant treatment. The study excludes stage IV, cN3, incomplete data, and patients receiving neoadjuvant therapy.<br /><br />Key findings reveal that roughly 20% of patients exhibit discordance between clinical and pathological stages, with 78.6% showing concordance. Notably, the rate of patients clinically staged as cN1 but pathologically as pN2 (more advanced nodal involvement) increased significantly over time—from 8.5% in 2004 to 20% in 2020—highlighting the rising risk of understaging nodes clinically. This underlines the importance of considering such discordance in treatment planning, especially regarding neoadjuvant immunotherapy.<br /><br />Risk factors associated with nodal upstaging include undergoing pneumonectomy (versus lobectomy), sampling fewer than 10 lymph nodes during surgery, surgical delays over 30 days, treatment at community centers, and Black race (for cN0/1 to pN2 upstaging). Adjusted odds ratios indicate pneumonectomy and inadequate lymph node sampling nearly double upstaging risk.<br /><br />The study sets a contemporary benchmark for clinical-pathological staging discrepancies and nodal risk. Its findings emphasize that clinical decisions in resectable NSCLC should carefully account for potential cTNM-pTNM discordance to optimize therapy selection and outcomes. These insights are especially relevant with the rising use of neoadjuvant immunotherapy, as understaging may affect eligibility and effectiveness.<br /><br />Authors are affiliated with Washington University School of Medicine and St. Louis VAMC, with support from NCDB. Key literature includes major NSCLC trials (CheckMate-816, KEYNOTE-671, AEGEAN), underscoring evolving treatment paradigms.

Asset Subtitle

Jeffrey Ward

Meta Tag

Speaker Jeffrey Ward

Topic Global Health, Health Services, and Health Economics

Keywords

non-small cell lung cancer

clinical staging

pathological staging

cTNM

pTNM

nodal upstaging

neoadjuvant therapy

pneumonectomy

lymph node sampling

treatment discordance