Be. Aggressive. B-E. Aggressive.

Aggressive nodal staging does not always translate to better outcomes (looking at you, anal cancer). But when it comes to non-small cell lung cancer (NSCLC), something has to explain the startling differences in outcomes between Asian and North American patients with NSCLC of the same stages. Yesterday’s JAMA onc investigation aimed to prospectively determine what, if any, effect the extent of nodal staging has on overall survival. Among several hospitals across three southeastern states, >2K NSCLC patients were graded on extent of pathologic nodal staging and observed for outcomes. As the stringency of nodal sampling improved, so did overall survival, with the greatest improvement seen among those with at least 3 or greater mediastinal stations examined. Importantly, these stratified outcomes occurred within quite a homogenous cohort. Why do we care? Well, this clearly supports current NCCN recommendations for sampling at least 10 nodes from at least 3 mediastinal stations, but the uptake remains poor. What we say: Quality measures are coming to the forefront whether we like it or not, so they may as well make sense.