Invasive Mediastinal Staging for Lung Cancer by The Society of Thoracic Surgeons Database Participants

Abstract

The STS-GTSD participants performed invasive mediastinal staging more frequently than prior reports, and yet only in a minority of patients. Rates of invasive mediastinal staging vary widely across STS-GTSD participants.

Outcomes of surgery versus chemoradiotherapy in patients with clinical or pathologic stage N3 non–small cell lung cancer

“…Our study reinforces the importance of invasive nodal staging, especially as studies suggest that a minority of patients nationwide receive invasive staging with significant center variability. 22,23 Further, in a subgroup analysis of cN3 patients who underwent induction therapy and surgery, we found an 87% pathologic nodal downstaging rate, suggesting that patients with good response to induction therapy were more likely to receive surgery and experience improved survival.…”

Commentary: Invasive mediastinal staging for lung cancer—Quality gap, evidence gap, both?

“…Low and variable rates of invasive mediastinal staging form the basis of a perceived gap in the quality of lung cancer care. [1][2][3] A recent prospective study of individuals with suspected or confirmed nonmetastatic lung cancer staged by computed tomography and positron emission tomography showed that 74% had at least one guidelinerecommended indication for invasive mediastinal staging 4 -suggesting that previously reported rates (21%-34%) are lower than they should be. What remains missing is high-level evidence linking process to outcome.…”

Commentary: To ignore evil is to become an accomplice to it—predicting malignancy in mediastinal lymph nodes

“…7 However, a recent analysis of the Society of Thoracic Surgeons General Thoracic Surgery Database showed that 57% of patients with non-small cell lung cancer clinical stages IB to IIIA did not undergo invasive mediastinal staging. 8 Ignoring the potential evil residing in the mediastinal lymph nodes results in suboptimal outcomes. Therefore, the real hurdle is getting surgeons and patients into the room to have the mediastinum sampled.…”