Narrative review of the staging classification controversy in stage N3 small cell lung cancer: from the perspective of overlapping Veterans Administration Lung Study Group and International Association for the Study of Lung Cancer definitions

By: Xinyu Chen · Qilin Wang · Juncai Ye · Xueping Yang · Jiahao Chen · Guangzeng Zhou · Chuanyu You · Tian Xu · Yan Gui

11 September 2026 at 18:00

J Thorac Dis. 2026 Aug 31;18(8):950. doi: 10.21037/jtd-2026-1704. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND AND OBJECTIVE: Traditionally, two primary systems have been employed for staging small cell lung cancer (SCLC): the Veterans Administration Lung Study Group (VALG) system and the International Association for the Study of Lung Cancer (IASLC) tumor, node, metastasis (TNM) system. The term "limited disease" is defined differently: VALG characterizes it as disease encompassed within a single tolerable radiation field, while IASLC defines it as the lack of distant metastases (M0). Patients with N3 disease frequently satisfy VALG extensive-stage (ES) criteria while meeting IASLC limited-stage (LS) criteria, resulting in a notable staging discrepancy. Therefore, this review aims to clarify the clinical challenges posed by this staging overlap and provide insights for standardizing staging terminology and optimizing therapeutic decision-making in N3 SCLC.

METHODS: A narrative review utilizing a systematized search strategy was conducted. While strict adherence to PRISMA guidelines was not pursued because the extensive heterogeneity of the literature precluded a formal meta-analysis, rigorous search criteria were applied to minimize selection bias. Databases including PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched for literature from January 2000 to March 2026. Studies examining stage N3 SCLC, spatial metastatic burden, and definitional inconsistencies between the VALG and IASLC staging systems were analyzed to assess their effects on treatment dosimetry, systemic therapy, and survival outcomes.

KEY CONTENT AND FINDINGS: The staging overlap in N3 SCLC leads to heterogeneous clinical management depending on its spatial metastatic burden, and this highly variable cohort can be stratified into distinct prognostic subgroups based on the anatomical distribution (single-region vs. multi-region) of the involved lymph nodes.

CONCLUSIONS: These findings should guide clinical trial design and terminology. Clinical decision-making must transcend historical paradigms and technical constraints. Future strategies must incorporate spatial evaluations of metastatic burden alongside innovative multimodal tools, such as artificial intelligence (AI) and multi-omics, to facilitate tailored therapy for SCLC.

PMID:42724560 | PMC:PMC13559235 | DOI:10.21037/jtd-2026-1704

Narrative review of the staging classification controversy in stage N3 small cell lung cancer: from the perspective of overlapping Veterans Administration Lung Study Group and International Association for the Study of Lung Cancer definitions

(Multiomics OR Omics) AND (Lung OR gastric OR Hepatocellular)

By: Xinyu Chen · Qilin Wang · Juncai Ye · Xueping Yang · Jiahao Chen · Guangzeng Zhou · Chuanyu You · Tian Xu · Yan Gui

11 September 2026 at 18:00

J Thorac Dis. 2026 Aug 31;18(8):950. doi: 10.21037/jtd-2026-1704. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND AND OBJECTIVE: Traditionally, two primary systems have been employed for staging small cell lung cancer (SCLC): the Veterans Administration Lung Study Group (VALG) system and the International Association for the Study of Lung Cancer (IASLC) tumor, node, metastasis (TNM) system. The term "limited disease" is defined differently: VALG characterizes it as disease encompassed within a single tolerable radiation field, while IASLC defines it as the lack of distant metastases (M0). Patients with N3 disease frequently satisfy VALG extensive-stage (ES) criteria while meeting IASLC limited-stage (LS) criteria, resulting in a notable staging discrepancy. Therefore, this review aims to clarify the clinical challenges posed by this staging overlap and provide insights for standardizing staging terminology and optimizing therapeutic decision-making in N3 SCLC.

METHODS: A narrative review utilizing a systematized search strategy was conducted. While strict adherence to PRISMA guidelines was not pursued because the extensive heterogeneity of the literature precluded a formal meta-analysis, rigorous search criteria were applied to minimize selection bias. Databases including PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched for literature from January 2000 to March 2026. Studies examining stage N3 SCLC, spatial metastatic burden, and definitional inconsistencies between the VALG and IASLC staging systems were analyzed to assess their effects on treatment dosimetry, systemic therapy, and survival outcomes.

KEY CONTENT AND FINDINGS: The staging overlap in N3 SCLC leads to heterogeneous clinical management depending on its spatial metastatic burden, and this highly variable cohort can be stratified into distinct prognostic subgroups based on the anatomical distribution (single-region vs. multi-region) of the involved lymph nodes.

CONCLUSIONS: These findings should guide clinical trial design and terminology. Clinical decision-making must transcend historical paradigms and technical constraints. Future strategies must incorporate spatial evaluations of metastatic burden alongside innovative multimodal tools, such as artificial intelligence (AI) and multi-omics, to facilitate tailored therapy for SCLC.

PMID:42724560 | PMC:PMC13559235 | DOI:10.21037/jtd-2026-1704

BEAT: Visual Backdoor Attacks on VLM-based Embodied Agents via Contrastive Trigger Learning

cs.AI, q-bio.NC updates on arXiv.org

By: Qiusi Zhan · Hyeonjeong Ha · Rui Yang · Sirui Xu · Hanyang Chen · Liang-Yan Gui · Yu-Xiong Wang · Huan Zhang · Heng Ji · Daniel Kang

24 February 2026 at 13:00

arXiv:2510.27623v3 Announce Type: replace Abstract: Recent advances in Vision-Language Models (VLMs) have propelled embodied agents by enabling direct perception, reasoning, and planning task-oriented actions from visual inputs. However, such vision-driven embodied agents open a new attack surface: visual backdoor attacks, where the agent behaves normally until a visual trigger appears in the scene, then persistently executes an attacker-specified multi-step policy. We introduce BEAT, the first framework to inject such visual backdoors into VLM-based embodied agents using objects in the environments as triggers. Unlike textual triggers, object triggers exhibit wide variation across viewpoints and lighting, making them difficult to implant reliably. BEAT addresses this challenge by (1) constructing a training set that spans diverse scenes, tasks, and trigger placements to expose agents to trigger variability, and (2) introducing a two-stage training scheme that first applies supervised fine-tuning (SFT) and then our novel Contrastive Trigger Learning (CTL). CTL formulates trigger discrimination as preference learning between trigger-present and trigger-free inputs, explicitly sharpening the decision boundaries to ensure precise backdoor activation. Across various embodied agent benchmarks and VLMs, BEAT achieves attack success rates up to 80%, while maintaining strong benign task performance, and generalizes reliably to out-of-distribution trigger placements. Notably, compared to naive SFT, CTL boosts backdoor activation accuracy up to 39% under limited backdoor data. These findings expose a critical yet unexplored security risk in VLM-based embodied agents, underscoring the need for robust defenses before real-world deployment.

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