Advances in surgical staging and therapy of non-small-cell lung cancer.

Surgical-pathological staging of patients with NSCLC, we believe, should form the basis of protocol development and design. To a large extent, it has been the lack of precise surgical staging of patients with NSCLC before therapy that has complicated the appropriate interpretation of treatment results in reported series. We now have the opportunity, with the advent of minimally invasive techniques, to build on the foundations laid by Harken, Carlen, Pearson, and others who developed mediastinoscopy to its full extent. We can further refine preresectional staging of patients with lung cancer to bring maximal application of standard staging systems and molecular prognostic variables to protocol design. There should be no room and no need for treatment strategies or protocol designs that do not incorporate rigorous surgical pathological staging before therapy in patients with NSCLC.