STS: Assessment of More Than One Nodal Station Tied to Increased Upstaging, Survival in NSCLC

THURSDAY, Feb. 5, 2026 (HealthDay News) — For adults with clinically node-negative non-small cell lung cancer (NSCLC), assessment of more than one N1 nodal station is associated with increased nodal upstaging and improved survival, according to a study presented at the annual meeting of the Society of Thoracic Surgeons, held from Jan. 29 to Feb. 1 in New Orleans.

Christopher W. Seder, M.D., from Rush University Medical Center in Chicago, and colleagues identified 48,779 adults who underwent wedge resection, segmentectomy, or lobectomy (18.5, 17.1, and 64.4 percent, respectively) for clinically node-negative NSCLC across 279 centers. Nodal upstaging and perioperative major morbidity rates were assessed, stratified by the extent of N1 (hilar/intrapulmonary) and N2 (mediastinal) lymph node station assessment.

The researchers observed an 11.2 percent overall rate of pathologic nodal upstaging. With each additional N1 station assessed, the incremental increase in nodal upstaging rate was greater than with each additional N2 station assessed, with no impact on major perioperative morbidity. A total of 19.7 percent of patients were upstaged due to malignancy exclusively identified in intrapulmonary lymph nodes. Three-year overall survival was incrementally better with each additional N1 lymph node station sampled for longitudinally linked pathologic node-negative patients. Assessment of more N1 stations remained associated with improved overall survival after risk adjustment, which was more pronounced when intrapulmonary stations were assessed.

“The onus here is not only on surgeons for them to dissect more lymph nodes, but on pathologists to take the lung specimen we give them and do a very thorough evaluation of that lung specimen to get all the additional lymph nodes with cancer that are hiding in the specimen,” Seder said in a statement.

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