e20081 Background: Neoadjuvant therapy (NAT) has become standard of care for selected patients with resectable non–small cell lung cancer (NSCLC). Accurate and timely preoperative staging is essential to identify patients who may benefit from NAT prior to curative-intent surgery. We sought to evaluate real-world implementation of guideline-informed staging and treatment decisions in early-stage NSCLC and to identify potential barriers to appropriate NAT utilization. Methods: We conducted a retrospective chart review of patients with stage IB–IIIB NSCLC who underwent curative-intent surgical resection at an academic community medical center within our health system between April 1, 2023, and October 1, 2024. All included patients underwent preoperative staging with PET-CT. Clinical stage at diagnosis was compared with final pathologic stage at surgery. Time from first imaging suspicious for lung cancer to surgery (time to surgery; TTS) was calculated and compared between patients who were upstaged versus those whose stage remained unchanged. Results: Thirty-nine patients met inclusion criteria. Pathologic staging was unchanged in 20 patients (51%), while 19 patients (49%) were upstaged to stage IIA or higher at surgery. Among upstaged patients, upstaging occurred due to increased T stage in 8 patients, nodal positivity in 9 patients, and both T and N stage changes in 2 patients. The overall mean TTS was 96 days (median 75 days). Mean TTS was similar between patients with unchanged pathologic stage (mean 94 days; median 61 days) and those who were upstaged (mean 97 days; median 78 days). Staging changes are summarized in Table 1. Conclusions: Nearly half of patients with resected early-stage NSCLC were found to have more advanced disease at surgery than suggested by preoperative PET-CT, representing missed opportunities for consideration of standard-of-care NAT. These findings highlight limitations in current diagnostic staging and/or delays between imaging and surgery. Improved accuracy and timeliness of preoperative staging are critical to ensure appropriate multidisciplinary evaluation and optimal delivery of neoadjuvant therapy for eligible patients. Changes between preoperative clinical stage and final pathologic stage. Staging Outcome Number of Patients (n=39) Pathologic stage unchanged 20 Pathologic upstaging (any) 19 Upstaged by T stage only 8 Upstaged by N stage only 9 Upstaged by both T and N stage 2
Maity et al. (Thu,) studied this question.