Four percent matters

Studies like the International Early Lung Cancer Action Program (I-ELCAP) (1) have revolutionized our understanding of early-stage lung cancer and its management. In their recent article (2), Flores and colleagues challenge us with the notion that sublobar resection without mediastinal lymph node sampling may be an adequate treatment for clinical stage IA non-small cell lung cancer (NSCLC). Drawing on the database of the I-ELCAP project (1), they were able to stratify patients into two propensity matched cohorts who received mediastinal lymph node resection (MLNR) and those who did not. A solid statistical and survival analysis methodology failed to demonstrate any significant difference in overall survival between patients who received MLNR during their operation, and those who did not. The authors conclude that subsolid nodules less than 30 mm in diameter, and peripheral solid nodules less than 20 mm in diameter should be treated with sublobar resection without MLNR.