Survival of N Category–Stratified Non–Small Cell Lung Cancer

Lymph node staging is one of the most important factors determining the prognosis of resected non–small cell lung cancer (NSCLC), the other being an R0 resection. Pathologic lymph node (pN) assessment is more accurate than clinical assessment, and the thoroughness of pN examination affects the prognostic value. As Asamura et al point out, the International Association for the Study of Lung Cancer noted differences in prognosis for pN classification depending on geographic location. No universally accepted guidelines exist for what constitutes an adequate (thorough) pN examination. The National Comprehensive Cancer Network recommends a minimum of 3 or more mediastinal nodal stations, the American College of Surgeons Commission on Cancer recommends 10 total lymph nodes regardless of station, and the Union for International Cancer Control seventh edition recommends 6 total nodes, 3 from N1 and 3 from N2 stations.

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