Implications of the lymph nodal ratio in resected N1 non-small cell lung cancer

The management of early-stage non-small cell lung cancer (NSCLC) with clinically positive N1 lymph nodes (LNs) involves surgical resection if technically and medically feasible (1,2). Thereafter, many of these patients will be confirmed as pathologically N1, without involvement of N2 mediastinal nodal stations. However, it is well-recognized that N1 NSCLC represents a diverse and heterogeneous population, with varying rates of recurrence and survival (3). Hence, the goal of ongoing investigation has been to better delineate prognostic groups within this relatively ambiguous cohort, so as to optimally treat patients at various risk levels.