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Background <p>Preoperative CT-based clinical T staging guides surgical planning in lung adenocarcinoma, whereas pathological T staging remains the postoperative reference standard. Prior studies have demonstrated discordance between clinical and pathological TNM staging in lung cancer, but stage-specific T-stage migration, comparative prognostic value, and implications for surgical decision thresholds in lung adenocarcinoma remain insufficiently defined.</p> Methods <p>This retrospective multicenter cohort study included 10,767 patients with surgically resected invasive lung adenocarcinoma. Clinical tumor size and T stage were obtained from official preoperative CT reports using the maximum reported tumor diameter, whereas pathological tumor size and T stage were obtained from final surgical pathology reports. Concordance, stage migration, and receiver operating characteristic (ROC) performance were assessed across T categories. Survival analyses were performed in 6,279 patients with follow-up data, and C-index was used to compare the prognostic discrimination of clinical versus pathological tumor size.</p> Results <p>CT-based tumor size exceeded pathological measurement on average (mean, 1.83&#xa0;cm vs. 1.51&#xa0;cm), with downstaging predominating across cT1c–T3 tumors. Clinical–pathological T-stage agreement followed a stage-dependent pattern, with concordance highest at the extremes (T1a, T4) and lowest at intermediate stages, a finding supported by ROC analysis. Both clinical and pathological T staging stratified disease-free and overall survival. C-index analysis suggested a modest stage-dependent crossover in prognostic discrimination: clinical tumor size showed better discrimination in early-stage disease (cT1a–T1b), whereas pathological tumor size performed better in advanced stages (T3–T4).</p> Conclusions <p>Clinical and pathological T staging provide complementary, context-dependent information across the disease spectrum. Clinical staging showed higher concordance with pathological staging and slightly better prognostic discrimination in early-stage tumors (T1a–T1b), whereas pathological staging offered stronger discrimination in advanced disease. These findings refine the interpretation of T staging in resected invasive lung adenocarcinoma by emphasizing measurement source, disease-stage context, and uncertainty around operative decision thresholds.</p>

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Stage-dependent prognostic value of clinical and pathological T staging in resected lung adenocarcinoma: a multicenter cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Libing Yang,
  • Chao Guo,
  • Xin Du,
  • Shanqing Li,
  • Jiaolong Wang,
  • Dawei Wang,
  • Haoqiang Chi,
  • Dianpeng Shi,
  • Hui Zhang,
  • Lan Song,
  • Lei Yu,
  • Yeye Chen

摘要

Background

Preoperative CT-based clinical T staging guides surgical planning in lung adenocarcinoma, whereas pathological T staging remains the postoperative reference standard. Prior studies have demonstrated discordance between clinical and pathological TNM staging in lung cancer, but stage-specific T-stage migration, comparative prognostic value, and implications for surgical decision thresholds in lung adenocarcinoma remain insufficiently defined.

Methods

This retrospective multicenter cohort study included 10,767 patients with surgically resected invasive lung adenocarcinoma. Clinical tumor size and T stage were obtained from official preoperative CT reports using the maximum reported tumor diameter, whereas pathological tumor size and T stage were obtained from final surgical pathology reports. Concordance, stage migration, and receiver operating characteristic (ROC) performance were assessed across T categories. Survival analyses were performed in 6,279 patients with follow-up data, and C-index was used to compare the prognostic discrimination of clinical versus pathological tumor size.

Results

CT-based tumor size exceeded pathological measurement on average (mean, 1.83 cm vs. 1.51 cm), with downstaging predominating across cT1c–T3 tumors. Clinical–pathological T-stage agreement followed a stage-dependent pattern, with concordance highest at the extremes (T1a, T4) and lowest at intermediate stages, a finding supported by ROC analysis. Both clinical and pathological T staging stratified disease-free and overall survival. C-index analysis suggested a modest stage-dependent crossover in prognostic discrimination: clinical tumor size showed better discrimination in early-stage disease (cT1a–T1b), whereas pathological tumor size performed better in advanced stages (T3–T4).

Conclusions

Clinical and pathological T staging provide complementary, context-dependent information across the disease spectrum. Clinical staging showed higher concordance with pathological staging and slightly better prognostic discrimination in early-stage tumors (T1a–T1b), whereas pathological staging offered stronger discrimination in advanced disease. These findings refine the interpretation of T staging in resected invasive lung adenocarcinoma by emphasizing measurement source, disease-stage context, and uncertainty around operative decision thresholds.