New data from a post-hoc analysis of the Assessment of Surgical Staging vs Endosonographic Ultrasound in Lung Cancer (ASTER) trial found no survival difference at 5 years with endosonography or mediastinoscopy (surgical staging) for mediastinal nodal staging of potentially resectable non–small cell lung cancer, according to a research letter published online in JAMA.
Researchers from the Netherlands obtained survival data for 241 patients who underwent endosonographic staging or surgical staging; two patients from each group were lost to follow-up. The prevalence of mediastinal nodal metastases was 54% in the endosonographic strategy group and 44% in the mediastinoscopy strategy group.
-----
Related Content
The Place for Biosimilars in Clinical Pathways
New criteria for identifying MET-driven lung cancer
-----
Survival at 5 years was the same for both treatment groups (35%; odds ratio [OR], 0.97; 95% confidence interval [CI], 0.57-1.66). The estimated mean survival was 31 months (95% CI, 21-41) for the endosonographic strategy compared with 33 months (95% CI, 23-43) for the surgical strategy. In subgroups with N2/N3 metastases or N0/N1 metastases, the 5-year survival was also similar. For patients with N2/N3 metastases, survival was 17% in the endosonographic staging vs 19% in the surgical strategy (OR, 0.87; 95% CI, 0.34-2.25); for patients with N0/N1 metastases, survival was 54% for endosonographic group vs 48% for the mediastinoscopy group (OR, 1.27; 95% CI, 0.62-2.60).
Since the original results of the ASTER trial published in 2010 in JAMA, which showed that endosonographic strategy was significantly more sensitive for diagnosing nodal metastases than surgical staging (94% vs 79%), guidelines on lung cancer management underwent significant revisions. They now advocate endosonography over mediastinoscopy as the first step for mediastinal staging because it is more accurate, less invasive, and reduces unnecessary thoracotomies.
The researchers attributed the fact that the ASTER trial was powered to detect a difference in diagnostic sensitivity, not survival, as reflected by the wide CIs as a rationale for why improved mediastinal staging did not lead to improved survival.
