Thorac Cancer. 2026 Mar;17(6):e70267. doi: 10.1111/1759-7714.70267.
ABSTRACT
INTRODUCTION: Accurate 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.
METHOD: Retrospective review of all patients with early-stage NSCLC referred by our lung cancer MDT for definitive surgical management between January 2019 and December 2023.
RESULTS: The 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.
CONCLUSION: For 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.
PMID:41850889 | DOI:10.1111/1759-7714.70267