The Annals of thoracic surgery · 2026
Comparing Nodal Upstaging Rates and Morbidity and Mortality of Common Nodal Sampling Guidelines in the STS General Thoracic Surgery Database.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Potter Alexandra L, Wang Danny, Bonnell Levi, Jacobs Ryan C, Martin Linda W, Lanuti Michael, Towe Christopher W, Woodard Gavitt A, Mullet Timothy, Seder Christopher W, Habib Robert H, Krantz Seth B, Yang Chi-Fu Jeffrey
Аннотация
BACKGROUND: To compare nodal upstaging and morbidity and mortality (M&M) rates for Operative Standard 5.8 vs other nodal sampling guidelines.
METHODS: Patients who underwent clinical stage I-IIIA non-small cell lung cancer resection between July 1, 2021 and December 31, 2024, were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database. We evaluated nodal upstaging and M&M rates for Operative Standard 5.8, a modified European Society for Thoracic Surgery (ESTS) lobe-specific guideline, a lobe-specific guideline based on work from Japan ("modified Japanese guideline"), and a hypothetical "2+1" guideline (≥2 mediastinal and ≥1 hilar station sampled). Odds of nodal upstaging and M&M for patients who met each guideline vs no guideline were compared using multivariable logistic regression.
RESULTS: Of 46,954 patients, 68.7% met Operative Standard 5.8, 32.4% met the modified ESTS guideline, 25.9% met the modified Japanese guideline, 83.9% met the 2+1 guideline, and 16.1% met no guideline. Nodal upstaging rates were 11.6% for Operative Standard 5.8, 11.7% for the modified ESTS guideline, 11.5% for the modified Japanese guideline, 11.5% for the 2+1 guideline, and 7.6% for patients who met no guideline. M&M rates were nearly identical across the 4 guidelines (5.2%-5.3%) and similar to those among patients who met no guideline (4.9%). Findings were consistent in multivariable-adjusted analyses.
CONCLUSIONS: In the Society of Thoracic Surgeons General Thoracic Surgery Database, nodal upstaging and M&M rates were comparable between Operative Standard 5.8 and the modified ESTS, modified Japanese, and 2+1 guidelines, supporting similar performance of these nodal sampling strategies. Upstaging rates were higher for patients who met any guideline vs none.
METHODS: Patients who underwent clinical stage I-IIIA non-small cell lung cancer resection between July 1, 2021 and December 31, 2024, were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database. We evaluated nodal upstaging and M&M rates for Operative Standard 5.8, a modified European Society for Thoracic Surgery (ESTS) lobe-specific guideline, a lobe-specific guideline based on work from Japan ("modified Japanese guideline"), and a hypothetical "2+1" guideline (≥2 mediastinal and ≥1 hilar station sampled). Odds of nodal upstaging and M&M for patients who met each guideline vs no guideline were compared using multivariable logistic regression.
RESULTS: Of 46,954 patients, 68.7% met Operative Standard 5.8, 32.4% met the modified ESTS guideline, 25.9% met the modified Japanese guideline, 83.9% met the 2+1 guideline, and 16.1% met no guideline. Nodal upstaging rates were 11.6% for Operative Standard 5.8, 11.7% for the modified ESTS guideline, 11.5% for the modified Japanese guideline, 11.5% for the 2+1 guideline, and 7.6% for patients who met no guideline. M&M rates were nearly identical across the 4 guidelines (5.2%-5.3%) and similar to those among patients who met no guideline (4.9%). Findings were consistent in multivariable-adjusted analyses.
CONCLUSIONS: In the Society of Thoracic Surgeons General Thoracic Surgery Database, nodal upstaging and M&M rates were comparable between Operative Standard 5.8 and the modified ESTS, modified Japanese, and 2+1 guidelines, supporting similar performance of these nodal sampling strategies. Upstaging rates were higher for patients who met any guideline vs none.