Cons: should a patient with stage IA non-small cell lung cancer undergo invasive mediastinal staging?

Abstract

Editor's note:In the era of personalized medicine, a critical appraisal new developments and controversies are essential in order to derived tailored approaches. In addition to its educative aspect, we expect these discussions to help younger researchers to refine their own research strategies.

Presurgical invasive mediastinal staging in lung cancer, unexpected N2 and long-term survival: a registry-based study with data from the Spanish group for video-assisted thoracic surgery

“…On the other hand, given that the main benefit of identifying N2 before surgery is to be able to provide neoadjuvant therapy, it would be interesting to have stronger evidence on its superiority over adjuvant therapy, to justify more invasive mediastinal staging. Based on data in the literature, Decaluwé and Dooms estimated that between 580 and 2,900 invasive procedures would be necessary to save one life after 5 years ( 30 ). There is still no consensus on the best time to give complementary chemotherapy ( 31 ).…”

Resultados de la estadificación clínica ganglionar mediastínica del cáncer pulmonar quirúrgico: datos de la cohorte prospectiva nacional del Grupo Español de Cirugía Torácica Videoasistida

“…En dos estudios con modelos teo ´ricos de decisio ´n clı ´nica, basan la ganancia de an ˜os ajustados por calidad en datos de supervivencia publicados en la literatura y no en efectos directos de una estrategia de estadificacio ´n26,28 . Por otra parte, Decaluwe ´et al reflexionan que habrı ´a que saber el beneficio en supervivencia de administrar tratamiento neoadyuvante en un N2 previo a la cirugı ´a, frente a administrar tratamiento adyuvante tras hallar un pN2 inesperado 29 . Basado en datos de la literatura, estima que serı ´an necesarias entre 580 y 2.900 pruebas invasivas para salvar una vida a los cinco an ˜os.…”