A number of studies, referenced by Lee and colleagues,1 have tried to determine whether the number of metastatic lymph nodes, recorded either as an absolute number or as a lymph node ratio, predicts survival better than anatomic location of involved nodes. The staging systems for several other solid tumors (eg, breast, colon, and melanoma) use the number of metastatic lymph nodes to establish N category and overall tumor stage. In the seventh edition of the international cancer staging systems,3,4 new evidence about the factors predicting overall survival in esophageal cancer led to a switch from lymph node location to the number of metastatic lymph nodes, thereby harmonizing the staging systems for esophagus and stomach. However, to date in lung cancer, analyses have failed to show that lymph node number supersedes anatomic location as a prognostic factor. Analyses of the IASLC database did show, though, that the number of involved levels of lymph nodes (ie, single vs multiple station N1 or N2), and, hence, the burden of locoregional metastatic disease, correlated with survival.7 In addition, it is still difficult to assess the number of metastatic lymph nodes clinically in lung cancer even with contemporary imaging studies and endobronchial ultrasound. For pathologic staging, accurate counting of involved lymph nodes assumes that the surgeon is doing a complete lymph node dissection, is removing nodes whole rather than in fragments, and is labeling nodes individually for the pathologist. This standard of surgical practice is rarely attained. Thus, at present, both scientific evidence and the considerations of routine clinical practice support continuing to use lymph node location rather than the number of metastatic nodes to determine nodal and overall stages. Ongoing analyses of an expanded IASLC lung cancer database, not yet published, suggest that lymph node location will remain the method of assessing N category in the upcoming eighth edition of the international cancer staging systems.