Evidence map›Paper›PMID 41510389›Full record

ArticleTranslational lung cancer research2025

Clinical characteristics of post-operative N2 nodal upstaging in non-small cell lung cancer: a retrospective cohort study.

Sun Young Choi, Myung Jin Song, Byung Soo Kwon, Yeon Wook Kim, Jong Sun Park, Sukki Cho, Jae Ho Lee, Choon-Taek Lee, Sung Yoon Lim

Abstract read
In one paragraph

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.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. PreoperativeTranslational lung cancer research · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sun Young ChoiDepartment of Critical Care Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.ORCID https://orcid.org/0000-0003-3245-5483
Myung Jin SongDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0003-2218-8959
Byung Soo KwonDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Yeon Wook KimDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0001-8333-4812
Jong Sun ParkDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0003-3707-3636
Sukki ChoDepartment of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0002-9309-8865
Jae Ho LeeDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0002-4766-1231
Choon-Taek LeeDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0001-8030-3332
Sung Yoon LimDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.ORCID https://orcid.org/0000-0003-3161-8711

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA)lung cancernodal upstaging

Identifiers

PMID41510389
PMCPMC12775689

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.