ArticleThoracic cancer2026
Clinical Versus Pathologic Staging in Early-Stage Non-Small Cell Lung Cancer Assessed by an Established Lung Cancer Multidisciplinary Meeting.
Article in Thoracic cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionAccurate clinical staging of early-stage non-small cell lung cancer (NSCLC) is critical to guide treatment recommendations. Clinical and pathological staging concordance for NSCLC is a quality indicator of lung cancer care. We compared clinical and pathological staging of early-stage NSCLC assessed by an established lung cancer multidisciplinary team (MDT), focusing on clinical under-staging.
methodRetrospective review of all patients with early-stage NSCLC referred by our lung cancer MDT for definitive surgical management between January 2019 and December 2023.
resultsThe cohort included 259 patients. The median time from review by respiratory service and referral to cardiothoracic surgery was 82 (IQR 59-132) days. Time from MDT discussion to surgery was 28 (IQR 18-41.5) days. Overall clinical and pathologic staging concordance occurred in 73% of cases, with 18.9% of cases clinically under-staged. Factors associated with clinical under-staging were time between sentinel CT imaging and surgery (p = 0.01) and histopathologic evidence of visceral pleural (p = 0.003), vessel (p = 0.031) and lymphatic (p = 0.014) invasion. At follow-up there was a significantly increased risk of mortality (OR 2.06, p = 0.003) and disease recurrence (OR 2.06, p = 0.037) for clinically under-staged patients. Discrepancies which may have led to different treatment decisions occurred in 18 (7%) patients.
conclusionFor patients diagnosed with early-stage NSCLC referred for curative surgical management, disagreement between clinical and pathologic staging may be due to treatment delay and malignancy histopathological features. Clinically under-staging increases risk of morbidity and mortality, which could be addressed through improved timeliness of care. Concordance of clinical and pathologic staging should be a routinely assessed benchmark for all lung cancer MDTs.
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