ArticleThe Annals of thoracic surgery2025
Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection.
Article in The Annals of thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Efficacy of Adjuvant Chemoimmunotherapy versus Chemotherapy and the Impact of Lymph Node Dissection on Survival.Annals of surgical oncology · 2026Article
- Association of resection type, nodal evaluation, and survival in early-stage lung squamous cell carcinoma.Journal of thoracic disease · 2026Article
- Prognostic Impact of Inadequate Lymph Node Evaluation in Early-Stage Lung Adenocarcinoma with Micropapillary or Solid Components.Annals of surgical oncology · 2026Article
- Lymph Node Dissection and Postoperative Complications After Lung Cancer Resection.JAMA network open · 2026Article
- Outcomes Linked to 3N2+1N1 Sampling by Surgery Type: A Commission on Cancer Lung Cancer Quality Metric.Annals of thoracic surgery short reports · 2026Article
- Optimizing Lymph Node Staging in Non-Small Cell Lung Cancer Surgery: Evidence, Guidelines, and Quality Improvement Strategies.Journal of clinical medicine · 2026Review
- Radiomics to understand pre-treatment tumor biology for resectable non-small cell lung cancer.Frontiers in oncology · 2026Review
- Survival following sublobar resection after neoadjuvant therapy for T1N1-2M0 lung cancer.PloS one · 2026Article
- Early compliance with lung cancer lymph node standard 5.8: An analysis of 2022 and 2023 Commission on Cancer site reviews.The Journal of thoracic and cardiovascular surgery · 2025Article
- Perspectives on Commission on Cancer Standard 5.8 on Lung Cancer: A Qualitative Study.The Journal of surgical research · 2025Article
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Abstract
backgroundThe newest Commission on Cancer standards recommend sampling 3 mediastinal and 1 hilar lymph node stations, 3 (N2) 1 (N1), for lung cancer resections. However, the relationship between the Commission on Cancer standards and outcomes has not been thoroughly investigated.
methodsA prospective institutional database was queried for clinical stage I-III lung resections before the implementation of the new standards. The relationship between the 3 (N2) 1 (N1) standard ("guideline concordant") and outcomes (upstaging, complications, receipt of adjuvant therapy, locoregional/distant recurrence, and survival) was assessed with multivariable models and stratified by stage.
resultsOf 9289 pulmonary resections, 3048 (33%) were guideline concordant and 6241 (67%) were not. Compared with nonconcordant, those that were guideline concordant had higher rates of nodal upstaging (21% vs 13%; odds ratio [OR], 1.32 [95% CI, 1.14-1.51]; P < .001) and in-hospital complications (34% vs 27%; OR, 1.17 [95% CI, 1.05-1.30]; P = .004) but similar adjuvant systemic therapy administration (19% vs 13%; OR, 1.09 [95% CI, 0.95-1.24]; P = .2; 98% chemotherapy). Locoregional and distant recurrences were not significantly improved with guideline concordance across clinical stage I, II, and III subsets. Overall survival was similar in clinical stages I and II, but improved survival was observed for guideline concordant clinical stage III patients (hazard ratio, 0.85 [95% CI, 0.74-0.97]; P = .02).
conclusionsSampling 3 (N2) 1 (N1) was associated with increased upstaging and complications but not with decreased recurrence or mortality in clinical stage I or II patients. Survival was improved for concordant, clinical stage III patients. Further study is indicated to determine the ideal lymph node sampling strategy across heterogeneous lung cancer patients.
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