Document Type

Article

Publication Date

1-31-2026

Comments

This article is the author’s final published version in Journal of Thoracic Disease, Volume 18, Issue 1, 2026, Article number 24.

The published version is available at https://doi.org/10.21037/jtd-2025-1728. Copyright © AME Publishing Company.

 

Abstract

BACKGROUND: There is significant value in predicting and better assessing patients who are at risk of post-surgery upstaging in lung cancer. The objective of this study is to review patients who were upstaged following resection and evaluate their clinical and demographic data to elucidate which factors portend an increased risk of pathologic upstaging at our institution (the Thomas Jefferson University Hospital).

METHODS: A retrospective review of institutional data was performed between 2011 and 2023. Patients with stage I-II non-small cell lung cancer (NSCLC) were included. Patients were excluded if they received neoadjuvant systemic therapy, including chemotherapy and/or immunotherapy, and were excluded if they received pre-operative mediastinoscopy or endobronchial ultrasound (EBUS). Kaplan-Meier analysis was utilized with log-rank testing to examine 5-year overall survival and progression-free survival. A logistic regression model was built to evaluate whether certain clinical or demographic factors affect the odds of being upstaged.

RESULTS: A total of 371 patients met the inclusion criteria. Male sex, primary tumor standardized uptake value (SUV) >8, pre-operative biopsy, and having 10-13 lymph nodes explored were all associated with increased odds of being upstaged. Squamous cell histology was associated with lower odds of upstaging compared to adenocarcinoma. Patients who had their tumor detected via a screening computed tomography (CT) scan had a trend towards a decreased odds of upstaging compared to symptomatic and incidentally found tumors.

CONCLUSIONS: Male gender, primary tumor SUV >8, having a preoperative biopsy, and having 10-13 lymph nodes explored were associated with increased odds of being upstaged. This analysis provides patients and clinicians with valuable data regarding upstaging early-stage lung cancers, which could be used to guide multidisciplinary teams in making more informed decisions regarding resection and the use of perioperative systemic therapy.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Additional Files
STROBE Statement.pdf (276 kB)
ICMJE DISCLOSURE FORM.pdf (857 kB)

PubMed ID

41660473

Language

English

Download

Share

COinS