ArticleTranslational lung cancer research2025
Clinical characteristics of post-operative N2 nodal upstaging in non-small cell lung cancer: a retrospective cohort study.
Article in Translational lung cancer research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- PreoperativeTranslational lung cancer research · 2026Article
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9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is widely used for mediastinal staging in non-small cell lung cancer (NSCLC). However, unexpected lymph node metastases leading to upstaging are often observed postoperatively. The characteristics of upstaged N2 lymph nodes and their impact on long-term survival remain unclear. This study verified whether postoperative N2 nodal upstaging in NSCLC has a greater impact on long-term survival than preoperatively diagnosed N2 disease. Methods: This retrospective study analyzed 177 patients with NSCLC with pathologically confirmed N2 lymph nodes after surgery. Preoperative staging was performed using computed tomography (CT), positron emission tomography-computed tomography (PET-CT), and EBUS-TBNA. Based on nodal staging discrepancies, patients were classified as N2-upstaged or unchanged. The primary outcome was 5-year overall survival, and the secondary outcome was progression-free survival (PFS). Results: Among 177 patients with postoperative N2-positive nodes, 53.1% (n=94) experienced nodal upstaging from preoperative N0 or N1. Upstaging was most commonly associated with subcarinal (38.3%) and aortic lymph nodes (21.3%), with 40% of the upstaged nodes measuring <5 mm. Five-year overall survival did not differ significantly between the upstaged and unchanged groups [hazard ratio (HR) 0.93, 95% confidence interval (CI): 0.60-1.45, P=0.76]. However, PFS was significantly higher in the upstaged group (HR 0.555, 95% CI: 0.336-0.915, P=0.02). Multivariate analysis identified nodal upstaging as an independent factor associated with improved PFS. Conclusions: Among patients with N2 NSCLC, N2 nodal upstaging-often due to small or inaccessible lymph nodes-did not significantly impact 5-year overall survival but was associated with improved PFS. These findings reinforce the clinical value of EBUS-TBNA as an effective tool for preoperative mediastinal staging in NSCLC despite its limitations in detecting small or inaccessible lymph nodes.
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