May 04, 2018
1 min read

Upstaging of lung cancer increases with surgery delay

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Upstaging of non-small cell lung cancers significantly increased with each successive week between staging and surgery, according to findings presented at the American Association for Thoracic Surgery Annual Meeting.

These data suggested that early intervention after tumor staging decreased the likelihood of upstaging and improved survival rates.

Guidelines recommend that patients with NSCLC undergo surgery within 8 weeks of staging.

“Our study evaluated the possibility of cancer upstaging using a more granular analysis, looking at the rates of upstaging for each progressive week from week 1 to week 12 for patients with stage I NSCLC,” Harmik J. Soukiasian, MD, chief of the division of thoracic surgery at Cedars-Sinai Health System, said in a press release.

The researchers reviewed treatment data from 52,406 patients with stage I NSCLC in the National Cancer Database. All patients underwent anatomic lobar resection and lymphadenectomy or lymph node sampling without chemotherapy. Soukiasian and colleagues evaluated the rates at which patients were upstaged based on the time from staging to resection for the first 12 weeks. Researchers also performed subgroup analyses for stage IA and IB adenocarcinoma and squamous cell carcinoma.

Resections were most frequently performed within 1 week (25.4%; n = 13,325), and nearly 80% (78.9%; n = 41,362) were performed by 8 weeks. Nearly all (91.2%; n = 77,844) had received surgery by 12 weeks.

Researchers noted significant increases in upstaging for all patients with stage I disease: 21.7% were upstaged after 1 week (n = 2,896 of 13,325), 31.5% (n = 961 of 3,046) were upstaged after 8 weeks (P < .05) and 32.6% (n = 366 of 1,027) were upstaged at 12 weeks.

“An astonishing number of clinical stage I NSCLC patients upstaged to IIIA disease at the time of surgery,” Soukiasian said. “Interestingly, a higher proportion of both clinical IA and IB patients upstaged to IIIA vs. IIB, suggesting a possible need for more aggressive mediastinal staging, even in early-staged patients. Although current national guidelines recommend surgery within 8 weeks from diagnosis, our study demonstrates there is a benefit in doing surgery even within a week-to-week basis.” – by Andy Polhamus


Serna-Gallegos DR, et al. Abstract 67. Presented at: American Association for Thoracic Surgery Annual Meeting; April 28-May 1, 2018; San Diego.

Disclosures: HemOnc Today could not confirm the authors’ relevant financial disclosures at the time of publication.