National Assessment of Adherence to Commission on Cancer Standard 5.8 and its Impact on Nodal Upstaging Rates and Operative Morbidity.

Abstract

Commission on Cancer (CoC) Standard 5.8 requires that 80% of curative resections for non-small cell lung cancer (NSLC) at any single institution have ≥3 N2 and ≥1 N1 lymph node stations assessed (3+1). We sought to assess national adherence rates and the impact on nodal upstaging and operative morbidity. Patients who underwent resection for clinical stage I-IIIA non-small cell lung cancer between 7/1/2021-12/31/2024 were identified from the Society of Thoracic Surgeons General Thoracic Surgical Database. We evaluated the percentage of resections that met the 3+1 standard. Rates of nodal upstaging and major morbidity or mortality were compared between those meeting the standard versus those who did not. Multivariable analysis was used to assess factors associated with meeting the standard. 34,871 of 52,497 (66.4%) patients had resections that met the 3+1 standard and this increased over time. Centers meeting ≥80% adherence increased from 19.3% to 43.5%. Factors associated with meeting the standard included Asian race (aOR 1.15; p<0.001), currently (1.22; p<0.001), or formerly smoking (aOR 1.11; p<0.001), and segmentectomy (aOR 2.67; p<0.001) or lobectomy (aOR 3.75; p<0.001). Pathologic nodal upstaging was higher in cases that met the 3+1 standard (aOR 1.19, [CI 1.12-1.27]). There were no differences in overall morbidity or mortality. The percentage of resection that met Standard 5.8 increased over time; however, most centers still did not meet the 80% adherence benchmark by the end of 2024. Adherence was associated with an increase in pathologic upstaging, without a corresponding increase in major morbidity or mortality.