Staging and Resectability in NSCLC

The Importance of Accurate Stage and Resectability Assessment

Prognosis is strongly correlated with disease stage in NSCLC1


The 5-year OS for NSCLC varies widely based on stage; therefore, accurate staging is crucial for assessing prognosis.1,2


5-year OS by stage1,*


NSCLC 5 year OS by stage 1
NSCLC 5 year OS by stage 1



*These outcomes represent the average overall survival of 94,708 patients based on clinical and pathological staging methods, in the IASLC global database receiving a diagnosis between 1999 and 2010.1 Outcomes have presumably improved since this study was conducted and variations exist depending on location and management of the patients. 

5-year OS differed based on clinical vs pathologic staging methods.


Proper stage and resectability assessment are critical for informing treatment decisions3


Surgical resection is typically recommended for early-stage NSCLC, whereas multimodality treatment is recommended for late-stage NSCLC. Most patients with stage III NSCLC have unresectable tumors5; however, due to the range of tumor sizes and nodal involvement included in stage III NSCLC, treatment decisions require a carefully planned, multifaceted approach.4


NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) treatment recommendations (summary) for stage III NSCLC6


NCCN Guidelines® treatment recommendations for stage 3 NSCLC
NCCN Guidelines® treatment recommendations for stage 3 NSCLC



Refer to the NCCN Guidelines for specific treatment recommendations, because not all agents in a drug class are recommended in these settings. For detailed recommendations, see the NCCN Guidelines for NSCLC (available at

T3N1 superior sulcus tumor.

§T4N0/1 superior sulcus tumor.

||T3N1 or T4N0-1 chest wall, proximal airway, or mediastinum.

T1-2 (other than invasive), N2.

#T3N1 (medically inoperable), T4N0-1 unresectable.

††For performance status 0-1 and no disease progression after concurrent CRT.

‡‡T3-4N2 (potentially resectable).

§§T3 (invasion), N2.

||||Stage IIIB T1-2N3 and T3-4N2 (unresectable).

¶¶Stage IIIC T3N3 and T4N3.

Accurate staging and resectability assessment can help estimate prognosis and determine the most appropriate treatment options for your patients with NSCLC.2,3

AJCC, American Joint Committee on Cancer; CRT, chemoradiation therapy; CT, chemotherapy; IASLC, International Association for the Study of Lung Cancer; NCCN, National Comprehensive Cancer Network; NSCLC, non–small cell lung cancer; OS, overall survival; RT, radiation therapy.


References: 1. Goldstraw P et al. Journal Thorac Oncol. 2016;11(1):39-51. 2. Amin MB et al. AJCC Cancer Staging Manual. 8th ed. Springer; 2017. 3. Steinfort DP et al. Medicine (Baltimore). 2016;95(8):e2488. 4. Detterbeck FC et al. Chest. 2013;143(5)(suppl):7S-37S. 5. Kantar Health CancerMPact. Accessed April 20, 2018. 6. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non–Small Cell Lung Cancer V4.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed April 29, 2019. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. To view the most recent and complete version of the guideline, go online to