000162581 001__ 162581 000162581 005__ 20260217205447.0 000162581 0247_ $$2doi$$a10.21037/jtd-23-1900 000162581 0248_ $$2sideral$$a145065 000162581 037__ $$aART-2024-145065 000162581 041__ $$aeng 000162581 100__ $$aLópez, Iker 000162581 245__ $$aPresurgical invasive mediastinal staging in lung cancer, unexpected N2 and long-term survival: a registry-based study with data from the Spanish group for video-assisted thoracic surgery 000162581 260__ $$c2024 000162581 5060_ $$aAccess copy available to the general public$$fUnrestricted 000162581 5203_ $$aBackground: Mediastinal lymph node staging is a key element in the diagnosis of lung cancer. The combination of computed tomography (CT) and positron emission tomography (PET) has improved staging but some circumstances are known to influence their negative predictive value. The objective of this study was to assess the impact on survival of avoiding invasive mediastinal staging in surgical lung cancer patients with negative mediastinum in CT and PET and intermediate risk of unexpected pN2. Methods: Data were collected from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS), from December 2016 to March 2018. For this study, patients were selected if they had negative mediastinum in CT and PET findings but tumours >3 cm or located centrally, or with cN1 disease. Patients who did and did not undergo invasive staging [invasive group (IG) and non-invasive group (NIG)] were compared, analysing unexpected pN2 and survival with Kaplan-Meier curves and Cox regression. Results: A total of 2,826 patients underwent surgery for primary lung cancer. We selected 1,247 patients who had tumours >3 cm, central tumours or cN1. Invasive staging was performed in 275 (22.1%) cases. The unexpected pN2 rate was 9.6% in the NIG and 13.8% in the IG, but half of them were discovered prior to surgery in the IG. Five-year overall survival (OS) was poorer in the IG (52.4% vs. 64%; P<0.001). In the Cox regression model, male sex, older age, diabetes, synchronous tumour, lower diffusing capacity for carbon monoxide, larger tumour size, higher pathological N-stage, and IG status were significant independent risk factors. Conclusions: Invasive staging recommended by guidelines could be reduced with an appropriate selection in mediastinal CT- and PET-negative patients with risk factors for unexpected pN2, because rates of pN2 and survival did not worsen without invasive staging. 000162581 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.es 000162581 592__ $$a0.624$$b2024 000162581 590__ $$a1.9$$b2024 000162581 593__ $$aPulmonary and Respiratory Medicine$$c2024$$dQ2 000162581 591__ $$aRESPIRATORY SYSTEM$$b67 / 108 = 0.62$$c2024$$dQ3$$eT2 000162581 594__ $$a3.3$$b2024 000162581 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000162581 700__ $$aAguinagalde, Borja 000162581 700__ $$aUrreta, Iratxe 000162581 700__ $$aRoyo, Iñigo 000162581 700__ $$aBolufer, Sergio 000162581 700__ $$aSánchez, Laura 000162581 700__ $$aZabaleta, Jon 000162581 700__ $$aFernández-Monge, Arantza 000162581 700__ $$0(orcid)0000-0003-0249-3104$$aEmbún, Raúl$$uUniversidad de Zaragoza 000162581 7102_ $$11013$$2090$$aUniversidad de Zaragoza$$bDpto. Cirugía$$cÁrea Cirugía 000162581 773__ $$g16, 5 (2024), 2856-2865$$pJ. thorac. dis.$$tJournal of thoracic disease$$x2072-1439 000162581 8564_ $$s322038$$uhttps://zaguan.unizar.es/record/162581/files/texto_completo.pdf$$yVersión publicada 000162581 8564_ $$s2387903$$uhttps://zaguan.unizar.es/record/162581/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000162581 909CO $$ooai:zaguan.unizar.es:162581$$particulos$$pdriver 000162581 951__ $$a2026-02-17-20:17:59 000162581 980__ $$aARTICLE