Department of Family Medicine, China Medical University Hospital, China Medical University, Taichung, 404327, Taiwan.
Changhua Christian Hospital, Changhua City, Taiwan.
Sci Rep. 2024 Nov 27;14(1):29441. doi: 10.1038/s41598-024-79158-9.
The standard treatment guideline for stage IIIA/N2 non-small cell lung cancer (NSCLC) remains controversial despite years of research, and the necessity of surgery is still debated. This study aims to explore optimal treatment and surgical methods for stage IIIA/N2 NSCLC patients.We obtained data from the Taiwan Cancer Registry (TCR) to compare the overall survival rates of different subgroups of stage IIIA/N2 NSCLC patients, as well as the overall survival rates of different treatment strategies and surgical methods.Our study included 2,237 stage IIIA/N2 NSCLC patients. Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy led to significantly higher survival rates. For T1N2 patients, surgery alone showed better survival (P < .001). Neoadjuvant chemotherapy with surgery and adjuvant chemotherapy provided higher survival for T2N2 and T3N2 patients (P < .001). Among surgical types, lobectomy had the lowest mortality rate, which was statistically significant.In conclusion, our study recommends neoadjuvant therapy followed by surgery and adjuvant therapy for improved survival in stage IIIA/N2 NSCLC patients. Surgery should not be excluded for resectable stage IIIA/N2 NSCLC patients, with lobectomy being the preferred option due to its significantly higher survival rate.
尽管经过多年的研究，III 期 A/N2 期非小细胞肺癌（NSCLC）的标准治疗指南仍然存在争议，手术的必要性仍存在争议。本研究旨在探讨 IIIA/N2 期 NSCLC 患者的最佳治疗和手术方法。
我们从台湾癌症登记处（TCR）获取数据，比较不同亚组 IIIA/N2 期 NSCLC 患者的总生存率，以及不同治疗策略和手术方法的总生存率。
我们的研究包括 2237 例 IIIA/N2 期 NSCLC 患者。新辅助化疗后手术和辅助化疗可显著提高生存率。对于 T1N2 患者，单独手术显示出更好的生存（P<0.001）。新辅助化疗联合手术和辅助化疗可提高 T2N2 和 T3N2 患者的生存率（P<0.001）。在手术类型中，肺叶切除术的死亡率最低，具有统计学意义。
总之，我们的研究建议对 IIIA/N2 期 NSCLC 患者进行新辅助治疗后手术和辅助治疗以提高生存率。对于可切除的 IIIA/N2 期 NSCLC 患者，不应排除手术，肺叶切除术是首选，因为其生存率显著提高。
