NSCLC survival comparable with endosonographic, surgical staging
medwireNews: Although endosonography has a significantly higher sensitivity for staging mediastinal nodal metastases than mediastinoscopy, this diagnostic benefit does not translate into a survival advantage in patients with non-small-cell lung cancer (NSCLC).
In a post-hoc analysis of the ASTER trial, 5-year survival was achieved by 35% of 121 patients with potentially resectable disease who were randomly assigned to undergo endosonographical staging, and by the same proportion of their 116 counterparts who underwent mediastinoscopy staging. The corresponding median survival times were a comparable 31 and 33 months.
Noting that accurate mediastinal nodal staging is known to have prognostic value, Jouke Annema (Academic Medical Center, Amsterdam, the Netherlands) and co-researchers wonder why improved mediastinal staging did not lead to a survival benefit.
They attribute it to the sample size as “ASTER was powered to detect a difference in diagnostic sensitivity, not survival”.
“If a survival difference between the strategies exists, it is likely to be small and a larger sample size may be needed to detect it”, Annema et al write in JAMA.
But they rule out the possibility of randomised trials to detect a survival difference as endosonographical staging is now recommended by clinical guidelines.
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