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. 2025 Feb;119(2):308-315.
doi: 10.1016/j.athoracsur.2024.09.009. Epub 2024 Sep 19.

Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection

Benjamin J Resio  1 , Kay See Tan  1 , Matthew Skovgard  1 , Joe Dycoco  1 , Prasad S Adusumilli  1 , Manjit S Bains  1 , Matthew J Bott  1 , Robert J Downey  1 , Katherine D Gray  1 , James Huang  1 , Daniela Molena  1 , Bernard J Park  1 , Valerie W Rusch  1 , Smita Sihag  1 , Gaetano Rocco  1 , David R Jones  1 , James M Isbell  2
Affiliations

Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection

Benjamin J Resio et al. Ann Thorac Surg. 2025 Feb.

Abstract

Background: The newest Commission on Cancer standards recommend sampling 3 mediastinal and 1 hilar lymph node stations, 3 (N2) 1 (N1), for lung cancer resections. However, the relationship between the Commission on Cancer standards and outcomes has not been thoroughly investigated.

Methods: A prospective institutional database was queried for clinical stage I-III lung resections before the implementation of the new standards. The relationship between the 3 (N2) 1 (N1) standard ("guideline concordant") and outcomes (upstaging, complications, receipt of adjuvant therapy, locoregional/distant recurrence, and survival) was assessed with multivariable models and stratified by stage.

Results: Of 9289 pulmonary resections, 3048 (33%) were guideline concordant and 6241 (67%) were not. Compared with nonconcordant, those that were guideline concordant had higher rates of nodal upstaging (21% vs 13%; odds ratio [OR], 1.32 [95% CI, 1.14-1.51]; P < .001) and in-hospital complications (34% vs 27%; OR, 1.17 [95% CI, 1.05-1.30]; P = .004) but similar adjuvant systemic therapy administration (19% vs 13%; OR, 1.09 [95% CI, 0.95-1.24]; P = .2; 98% chemotherapy). Locoregional and distant recurrences were not significantly improved with guideline concordance across clinical stage I, II, and III subsets. Overall survival was similar in clinical stages I and II, but improved survival was observed for guideline concordant clinical stage III patients (hazard ratio, 0.85 [95% CI, 0.74-0.97]; P = .02).

Conclusions: Sampling 3 (N2) 1 (N1) was associated with increased upstaging and complications but not with decreased recurrence or mortality in clinical stage I or II patients. Survival was improved for concordant, clinical stage III patients. Further study is indicated to determine the ideal lymph node sampling strategy across heterogeneous lung cancer patients.

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Conflict of interest statement

Disclosures James Isbell reports a relationship with LumaCyte that includes: equity or stocks; with Roche that includes: board membership; and with Genetech Biotech Co Ltd that includes: board membership and funding grants. Daniela Molena reports a relationship with Genetech Biotech Co Ltd that includes: board membership and funding grants; with AstraZeneca Pharmaceuticals LP that includes: board membership and consulting or advisory; with Johnson and Johnson Ltd that includes: consulting or advisory; with Bristol Myers Squibb Co that includes: consulting or advisory; and with Merck & Co Inc that includes: consulting or advisory. David Jones reports a relationship with Merck & Co Inc that includes: consulting or advisory; and with AstraZeneca Pharmaceuticals LP that includes: board membership and consulting or advisory. Matthew Bott reports a relationship with AstraZeneca Pharmaceuticals LP that includes: board membership and consulting or advisory. Prasad Adusumilli reports a relationship with Johnson and Johnson Ltd that includes: consulting or advisory; with Atara Biotherapeutics that includes: consulting or advisory; with Bayer Corporation that includes: consulting or advisory; with Carisma Therapeutics Inc that includes: consulting or advisory; with Imugene that includes: consulting or advisory; and with ImmPactBio that includes: consulting or advisory. Bernard Park reports a relationship with Intuitive Surgical Inc that includes: consulting or advisory; and with COTA, Inc that includes: consulting or advisory. Valerie Rusch reports a relationship with Genetech Biotech Co Ltd that includes: board membership and funding grants; with Intuitive Surgical Inc that includes: consulting or advisory; and with Genelux that includes: funding grants. Gaetano Rocco reports a relationship with AstraZeneca Pharmaceuticals LP that includes: board membership and consulting or advisory; with Scanlan International Inc that includes: consulting or advisory; and with Medtronic that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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