{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:47:28Z","timestamp":1791942448983,"version":"4.3.4"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"\n Importance<\/jats:title>\n Lymph node dissection for early-stage lung adenocarcinoma is controversial. Histologic pattern subtyping reveals heterogeneity of lung adenocarcinoma, yet its association with lymph node involvement and dissection is understudied.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association between guideline-adherent lymph node dissection, histologic pattern subtyping, and overall survival in patients with clinical T1N0M0 lung adenocarcinoma.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter cohort study used data from the National Cancer Center LungReal database, a multicenter, electronic health records-based database for patients undergoing surgery for lung cancer, from January 2014 to December 2021, with the last follow-up in December 2022. Patients were categorized based on histologic pattern of adenocarcinoma into 2 groups: lepidic without high-grade pattern, and high-grade or no lepidic pattern. The data analysis was performed from April to November 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Lymph node dissection adherence or nonadherence with the 3\u2009+\u20091 standard (3 N2 plus 1 N1 station) and the 6-station standard (the subcarinal plus 2 other N2 stations and 3 N1 stations).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n Overall survival.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 35 265 patients screened, 27\u202f191 participants (mean [SD] age, 58.3 [11.7] years; 16 280 female [59.9%] and 10\u202f911 male [40.1%] individuals) from 19 centers were included; among them, 15\u202f593 (57.3%) received lymph node dissection adherent with the 3\u2009+\u20091 standard and 4023 (14.8%) with the 6-station standard. Among the group of 13\u202f369 patients (49.2%) with adenocarcinoma of lepidic without high-grade pattern, no association was observed between survival and adherence with the 3\u2009+\u20091 standard (hazard ratio [HR], 0.81; 95% CI, 0.57-1.15) or the 6-station standard (HR, 0.54; 95% CI, 0.26-1.13). Whereas, among the group of 13\u202f822 patients (50.8%) with adenocarcinoma of high-grade or no lepidic pattern, adherence with the 3\u2009+\u20091 standard (HR, 0.81; 95% CI, 0.69-0.95; absolute risk difference at 3-year, 1.2%; 95% CI, 0.2%-2.2%; E-value, 1.78) or the 6-station standard (HR, 0.61; 95% CI, 0.45-0.83; absolute risk difference at 3 years, 1.0%; 95% CI, 0.1%-1.9%; E-value, 2.67) was associated with a significant but small absolute survival benefit.<\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance<\/jats:title>\n In this cohort study, guideline-adherent nodal dissection was associated with small absolute survival benefit for patients with adenocarcinoma of high-grade or no lepidic pattern, but not for those with lepidic without high-grade pattern. These observational findings warrant prospective validation and should not be interpreted as causal.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.5924","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T16:00:55Z","timestamp":1768492855000},"page":"266","source":"Crossref","is-referenced-by-count":7,"title":["Lymph Node Dissection Guideline Adherence and Survival in Patients With T1N0M0 Lung Adenocarcinoma"],"prefix":"10.1001","volume":"12","author":[{"given":"Renda","family":"Li","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingpeng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenran","family":"Wang","sequence":"additional","affiliation":[{"name":"Office of Cancer Screening, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ni","family":"Li","sequence":"additional","affiliation":[{"name":"Office of Cancer Screening, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Yang","sequence":"additional","affiliation":[{"name":"Office for Cancer Diagnosis and Treatment Quality Control, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengwei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"He","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"coi250082r2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.athoracsur.2021.05.051","article-title":"American College of Surgeons Commission on Cancer Standard for Curative-intent Pulmonary Resection.","volume":"113","author":"Nissen","year":"2022","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"coi250082r3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.lungcan.2005.01.001","article-title":"Complete resection in lung cancer surgery: proposed definition.","volume":"49","author":"Rami-Porta","year":"2005","journal-title":"Lung Cancer"},{"issue":"2","key":"coi250082r5","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.athoracsur.2024.09.009","article-title":"Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection.","volume":"119","author":"Resio","year":"2025","journal-title":"Ann Thorac Surg"},{"issue":"11","key":"coi250082r6","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.jtho.2022.08.009","article-title":"Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in early stage NSCLC.","volume":"17","author":"Heiden","year":"2022","journal-title":"J Thorac Oncol"},{"issue":"16","key":"coi250082r7","doi-asserted-by":"publisher","first-page":"8067","DOI":"10.1200\/JCO.2025.43.16_suppl.8067","article-title":"Commission on Cancer lung cancer surgery quality metric and overall survival in a population-based cohort.","volume":"43","author":"Ely","year":"2025","journal-title":"J Clin Oncol"},{"issue":"3","key":"coi250082r8","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.jtho.2019.11.009","article-title":"Beyond margin status: population-based validation of the proposed International Association for the Study of Lung Cancer Residual Tumor Classification Recategorization.","volume":"15","author":"Osarogiagbon","year":"2020","journal-title":"J Thorac Oncol"},{"issue":"7","key":"coi250082r9","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1016\/j.jtho.2022.03.015","article-title":"Reclassifying the International Association for the Study of Lung Cancer Residual Tumor Classification according to the extent of nodal dissection for NSCLC: one size does not fit all.","volume":"17","author":"Lee","year":"2022","journal-title":"J Thorac Oncol"},{"issue":"6","key":"coi250082r10","doi-asserted-by":"publisher","first-page":"2648","DOI":"10.1016\/j.jtcvs.2018.02.010","article-title":"Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage I non-small cell lung cancer.","volume":"155","author":"Cheng","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"10","key":"coi250082r11","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1016\/j.jtho.2020.06.001","article-title":"A grading system for invasive pulmonary adenocarcinoma: a proposal from the International Association for the Study of Lung Cancer Pathology Committee.","volume":"15","author":"Moreira","year":"2020","journal-title":"J Thorac Oncol"},{"issue":"10","key":"coi250082r12","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1016\/j.jtho.2021.07.006","article-title":"Validation of the novel International Association for the Study of Lung Cancer grading system for invasive pulmonary adenocarcinoma and association with common driver mutations.","volume":"16","author":"Deng","year":"2021","journal-title":"J Thorac Oncol"},{"issue":"1","key":"coi250082r13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1097\/JTO.0b013e318276274e","article-title":"Prognostic significance of predominant histologic pattern and nuclear grade in resected adenocarcinoma of the lung: potential parameters for a grading system.","volume":"8","author":"von der Th\u00fcsen","year":"2013","journal-title":"J Thorac Oncol"},{"issue":"1","key":"coi250082r14","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.jtho.2023.09.1443","article-title":"A Shift in paradigm: selective lymph node dissection for minimizing oversurgery in early stage lung cancer.","volume":"19","author":"Jiang","year":"2024","journal-title":"J Thorac Oncol"},{"issue":"8","key":"coi250082r15","doi-asserted-by":"publisher","first-page":"658","DOI":"10.7326\/0003-4819-139-8-200310210-00009","article-title":"The effect of clustering of outcomes on the association of procedure volume and surgical outcomes.","volume":"139","author":"Panageas","year":"2003","journal-title":"Ann Intern Med"},{"issue":"7223","key":"coi250082r16","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1136\/bmj.319.7223.1492","article-title":"Calculating the number needed to treat for trials where the outcome is time to an event.","volume":"319","author":"Altman","year":"1999","journal-title":"BMJ"},{"issue":"12","key":"coi250082r17","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/0895-4356(95)00510-2","article-title":"Importance of events per independent variable in proportional hazards analysis. I. Background, goals, and general strategy.","volume":"48","author":"Concato","year":"1995","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"coi250082r18","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1093\/ejcts\/ezw439","article-title":"Systematic lymphadenectomy versus sampling of ipsilateral mediastinal lymph-nodes during lobectomy for non-small-cell lung cancer: a systematic review of randomized trials and a meta-analysis.","volume":"51","author":"Mokhles","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"issue":"1","key":"coi250082r19","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.ejcts.2006.03.047","article-title":"Postoperative ischemic change in bronchial stumps after primary lung cancer resection.","volume":"30","author":"Satoh","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"issue":"64","key":"coi250082r20","doi-asserted-by":"publisher","DOI":"10.1126\/sciimmunol.abg7836","article-title":"A reservoir of stem-like CD8+ T cells in the tumor-draining lymph node preserves the ongoing antitumor immune response.","volume":"6","author":"Connolly","year":"2021","journal-title":"Sci Immunol"},{"issue":"1","key":"coi250082r21","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.trecan.2023.09.006","article-title":"The tumor-draining lymph node as a reservoir for systemic immune surveillance.","volume":"10","author":"Delclaux","year":"2024","journal-title":"Trends Cancer"},{"issue":"7","key":"coi250082r22","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.jtho.2023.02.010","article-title":"Selective mediastinal lymph node dissection strategy for clinical T1N0 invasive lung cancer: a prospective, multicenter, clinical trial.","volume":"18","author":"Zhang","year":"2023","journal-title":"J Thorac Oncol"},{"issue":"11","key":"coi250082r23","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1016\/j.ejso.2016.02.247","article-title":"Lymph node involvement influenced by lung adenocarcinoma subtypes in tumor size =3 cm disease: a study of 2268 cases.","volume":"42","author":"Yu","year":"2016","journal-title":"Eur J Surg Oncol"},{"issue":"4","key":"coi250082r24","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1093\/ejcts\/ezu007","article-title":"Surgical management of pulmonary adenocarcinoma presenting as a pure ground-glass nodule.","volume":"46","author":"Sim","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"coi250082r25","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.lungcan.2020.09.016","article-title":"Impact of histological components on selecting limited lymphadenectomy for lung adenocarcinoma =2 cm.","volume":"150","author":"Sun","year":"2020","journal-title":"Lung Cancer"},{"issue":"8","key":"coi250082r26","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1038\/modpathol.2015.71","article-title":"Accuracy of the IASLC\/ATS\/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections.","volume":"28","author":"Trejo Bittar","year":"2015","journal-title":"Mod Pathol"},{"key":"coi250082r27","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.lungcan.2023.02.010","article-title":"Frozen sections accurately predict the IASLC proposed grading system and prognosis in patients with invasive lung adenocarcinomas.","volume":"178","author":"Fan","year":"2023","journal-title":"Lung Cancer"},{"issue":"9","key":"coi250082r28","doi-asserted-by":"publisher","first-page":"5444","DOI":"10.1097\/JS9.0000000000001667","article-title":"Prediction of the pathological subtypes by intraoperative frozen section for patients with cT1N0M0 invasive lung adenocarcinoma (ECTOP-1015): a prospective multicenter study.","volume":"110","author":"Fu","year":"2024","journal-title":"Int J Surg"},{"issue":"6","key":"coi250082r29","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1007\/s11604-024-01534-2","article-title":"Prediction of solid and micropapillary components in lung invasive adenocarcinoma: radiomics analysis from high-spatial-resolution CT data with 1024 matrix.","volume":"42","author":"Ninomiya","year":"2024","journal-title":"Jpn J Radiol"},{"issue":"1","key":"coi250082r30","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s40644-025-00864-2","article-title":"Differentiating high-grade patterns and predominant subtypes for IASLC grading in invasive pulmonary adenocarcinoma using radiomics and clinical-semantic features.","volume":"25","author":"Zheng","year":"2025","journal-title":"Cancer Imaging"},{"key":"coi250082r4","volume-title":"Guidelines of Chinese Society of Clinical Oncology (CSCO) Non-Small Cell Lung Cancer","author":"Committee CSoCOG","year":"2025"},{"key":"coi250082r1","unstructured":"National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Non-Small Cell Lung Cancer. Accessed July 12, 2025. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/nscl.pdf"}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2843494\/jamaoncology_li_2026_oi_250082_1773666440.54326.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:00:29Z","timestamp":1773932429000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2843494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2025.5924","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}