ArticleJTCVS open2026
Nodal upstaging and neoadjuvant therapy in lung adenocarcinoma: Evidence of a missed opportunity?
Article in JTCVS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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11 authors.
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Abstract
Background: Nodal upstaging at time of lung adenocarcinoma resection is associated with worse outcomes. Using a large national cohort, we studied rates of upstaging and outcomes of patients with clinical stage IA-IIA disease who were upstaged due to positive nodes at surgery compared to patients with clinically node-positive stage IIB/IIIA who received neoadjuvant therapy (NT). Methods: We used National Cancer Database data from 2018 to 2022. Nodal upstaging was defined as patients clinical stage IA-IIA found to be pathologic stage IIB/IIIA due to positive nodes at surgery. Upstaged patients were compared to patients who were clinically node-positive stage IIB/IIIA and who received NT. Kaplan-Meier curves, log-rank tests, and adjusted Cox proportional hazard models were used to analyze survival. Results: Out of a total of 33,016 patients identified as clinical stage IA-IIA and node-negative, 4301 (13.0%) were upstaged due to positive nodes at surgery, with this rate increasing to 23.3% in clinical stage IIA patients. Patients who were clinical stage IA-IIA but upstaged at surgery were then compared to patients who were clinical stage IIB/IIIA and received NT (n = 1569). In an adjusted model, patients who were upstaged demonstrated worse survival (1.20 [1.00-1.44], Conclusions: In this large national cohort, a nodal upstaging rate of 13% was observed in patients undergoing lung resection for adenocarcinoma, and patients with nodal upstaging demonstrated worse survival compared to clinically node-positive patients who received NT. Patients who were clinical IIA had a higher rate of upstaging (23.3%), and investigation of empiric NT in this subpopulation may be warranted.
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