Reclassifying the International Association for the Study of Lung Cancer Residual Tumor Classification According to the Extent of Nodal Dissection for NSCLC: One Size Does Not Fit All

Multi-scale characterization of tumor-draining lymph nodes in resectable lung cancer treated with neoadjuvant immune checkpoint inhibitors

“…3,20,46,48 Recently, a retrospective study encompassing 5117 patients with clinical stage I-III NSCLC demonstrated that a less rigorous TDLNs resection was associated with significantly better 5-year RFS and OS. 58 These findings reinvoke our thoughts on the necessity of unselective TDLNs resection, particularly in the setting of immunotherapy. Notably, studies from other groups have shown in pre-clinical models that TDLNs play a pivotal role in PD-1/PD-L1-based immunotherapy, and that surgical resection of TDLNs before treatment hampers therapeutic outcomes.…”

Is it time to revise the International Association for the Study of Lung Cancer definitions of completeness of lung cancer resection?

“…Furthermore, when stratified according to pathologic stage, RFS and OS did not differ in the comparison of adenocarcinoma in situ (AIS) combined with minimally invasive adenocarcinoma (MIA), stages IA1 and IA2, but OS was significantly worse (P=0.021 for the 3-cohort comparison) in the noncompliant group with stage IA3 (Fig. S2 in Lee et al) (1).…”

“…The comparative recurrence free survival (RFS) and overall survival (OS) results were paradoxical: the partially compliant and noncompliant [R0(un)] cohorts had significantly better survival than the fully compliant (R0) cohort (Fig. 2 in Lee et al) (1). That is, patients in the cohorts with a less rigorous lymphadenectomy lived longer than those whose nodal assessment fulfilled the recommended requirements.…”

“…In a recent article published in the Journal of Thoracic Oncology , Lee et al . suggest that the International Association for the Study of Lung Cancer (IASLC) criteria for categorizing completeness of lung cancer resection should be revised and adapted to the pathologic type of the tumour, its biologic behaviour and its risk profile ( 1 ). Their conclusion is based on a detailed single tertiary care institution retrospective cohort study of 5,117 patients who had undergone complete (2,806 patients) or uncertain (2,311 patients) resections based on the IASLC definitions ( 2 ).…”

“…2 in Lee et al .) ( 1 ). That is, patients in the cohorts with a less rigorous lymphadenectomy lived longer than those whose nodal assessment fulfilled the recommended requirements.…”