TY - JOUR T1 - Trends in mediastinal nodal staging and its impact on unforeseen N2 and survival in lung cancer JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01549-2020 SP - 2001549 AU - Jelle E. Bousema AU - Mieke J. Aarts AU - Marcel G.W. Dijkgraaf AU - Jouke T. Annema AU - Frank J.C. van den Broek Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/early/2020/09/28/13993003.01549-2020.abstract N2 - Introduction Guidelines for invasive mediastinal nodal staging in resectable NSCLC have changed over the years. The aims of this study were to describe trends in invasive staging and unforeseen N2 (uN2) and to assess a potential effect on overall survival (OS).Methods A nationwide Dutch cohort study included all clinical stage IA-IIIB NSCLC patients primarily treated by surgical resection between 2005 and 2017 (n=22 555). We assessed trends in invasive nodal staging (mediastinoscopy, 2005–2017; endosonography, 2011–2017), uN2 and OS and compared outcomes in the entire group and in cN1–3 patients with or without invasive staging.Results An overall increase in invasive nodal staging from 26% in 2005 to 40% in 2017 was found (p<0.01). Endosonography increased from 19% in 2011 to 32% in 2017 (p<0.01), while mediastinoscopy decreased from 24% in 2011 to 21% in 2017 (p=0.08). Despite these changes uN2 was stable over the years at 8.7%. Five-year OS rate was 41% for pN1 compared to 37% in single node uN2 (p=0.18) and 26% with more than one node uN2 (p<0.01). Five-year OS rate of patients with cN1–3 with invasive staging was 44% versus 39% in patients without invasive staging (p=0.12).Conclusion A significant increase in invasive mediastinal nodal staging in patients with resectable NSCLC was found between 2011 and 2017 in the Netherlands. Increasing use of less invasive endosonography prior to (or substituting) surgical staging did not lead to more cases of uN2. Performance of invasive staging indicated a possible overall survival benefit in patients with cN1–3 disease.Funding This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Bousema has nothing to disclose.Conflict of interest: Dr. Aarts has nothing to disclose.Conflict of interest: Dr. Dijkgraaf has nothing to disclose.Conflict of interest: Dr. Annema reports non-financial support from Hitachi Medical systems, non-financial support from Pentax, grants from Cook medical, grants from Mauna Kea Technologies, outside the submitted work.Conflict of interest: Dr. van den Broek has nothing to disclose. ER -