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August 22, 2026BMC CancerOpen Access

Skip mediastinal metastasis versus pN1 and validation of 9th edition N substaging in lung cancer

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Authors

DSDonghyeon SonJSJoung Woo SonJLJoonseok Lee

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Overview

Retrospective cohort study reveals skip mediastinal metastasis achieves comparable recurrence-free survival to pN1 in lung cancer, indicating the need to refine nodal staging.

Key Points

  • To determine the prognostic significance of skip mediastinal (skip N2) metastasis, compare recurrence-free survival with pathological N1 (pN1) disease, and validate the 9th-edition N2 substaging system in resected non-small cell lung cancer.
  • Analyzed 1,118 patients with pathologically confirmed N1–N2 non-small cell lung cancer who underwent complete resection and systematic lymph node dissection between 2003 and 2022 at a single tertiary centre (pN1 n=622, skip N2 n=151, non-skip N2 n=345; median follow-up 44.5 months).
  • Applied propensity score matching with eight covariates to match 141 skip N2 patients with 258 pN1 patients with standardized mean differences < 0.1 to evaluate recurrence-free survival.
  • Skip N2 showed significantly higher 5-year recurrence-free survival compared to non-skip N2 disease (68.9% vs. 44.7%; adjusted HR 0.49, 95% CI 0.35–0.70; p < 0.001).
  • After propensity score matching, recurrence-free survival did not differ significantly between skip N2 and pN1 cohorts (HR 0.87, 95% CI 0.59–1.29; p = 0.50).
  • The 9th edition N2 substaging demonstrated distinct hierarchical 5-year recurrence-free survival across four groups: skip N2a (69.5%), skip N2b (51.9%), non-skip N2a (44.8%), and non-skip N2b (33.3%; p < 0.001).

Cite This Study

Son et al. (2026) studied this question.

synapsesocial.com/papers/6a895f2aca7ade938187d9d2https://doi.org/10.1186/s12885-026-16681-0
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prognostic impacts of skip metastasis in N2a and N2b subgroups of non-small cell lung cancer: insights from a large cohort2025
  2. 2A New N2 Descriptor for Resectable Non‐Small Cell Lung Cancer: The Classification Based on Skip Metastasis and the Number of N2 Station Involvement2026
  3. 3The prognostic significance of skip mediastinal lymphatic metastasis in resected non-small cell lung cancer2002 · 17 citations
  4. 4Prognostic significance of nodal subclassification and adjuvant therapy in surgically treated T1-4N1-2M0 non-small cell lung cancer: a single-center retrospective study2026
  5. 5Clinicopathologic characteristics and predictive nomogram of skip lymph node metastasis in gastric cancer2025