BACKGROUND: The optimal treatment for stage IIIA-N2 non-small cell lung cancer (NSCLC) remains controversial, and multidisciplinary team approaches are needed. Downstaging after induction therapy is a good prognostic factor in surgical patients; however, re-evaluation of nodal status before surgery is challenging. The aim of this study was to evaluate the prognosis of patients with multi-level N2 NSCLC who received surgery or chemoradiation therapy (CRT) according to restaging using endobronchial ultrasound-transbronchial aspiration (EBUS-TBNA). METHODS: This was a single center, prospective study that included 16 patients with biopsy-proven multi-level N2 disease on initial EBUS-TBNA that was restaged using EBUS-TBNA after induction therapy. Cases downstaged after rebiopsy were treated surgically. Three-year progression-free survival (PFS) and locoregional PFS were determined using Kaplan-Meier analysis. RESULTS: Of the 16 patients (median age 58 years, male 63%), eight had persistent N2 disease and eight showed N2 clearance on restaging using EBUS-TBNA. Ten patients underwent surgery, including two patients without N2 clearance. Recurrence and locoregional recurrence occurred in eight and five patients, respectively. The three-year PFS was longer in patients with N2 clearance than in those with N2 persistent disease (57.1% vs. 37.5%). Patients with N2 clearance also had longer three-year locoregional PFS than those with N2 persistent disease (71.4% vs. 62.5%). CONCLUSIONS: EBUS-TBNA could be an effective diagnostic method for restaging in multi-level N2 NSCLC patients after induction CRT. As this was a pilot study, further large-scale randomized studies are needed.