Fazlıoglu Mithat, Erdogu Volkan, Citak Necati, Fazlıoglu Nevin, Metin Muzaffer
Department of Thoracic Surgery, Tekirdag Namik Kemal University Medical Faculty, Tekirdag, 59030, Turkey.
Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery, Training and Research Hospital, Istanbul, Turkey.
BMC Pulm Med. 2025 Jul 19;25(1):344. doi: 10.1186/s12890-025-03822-7.
This study evaluates the role of surgery in selected stage IIIB/N2 non-small cell lung cancer (NSCLC) patients within a multimodal treatment approach. We focused on the impact of mediastinal downstaging, local tumor invasion, and postoperative complications on survival outcomes.
A retrospective analysis was conducted on 1752 NSCLC patients who underwent surgery between 2010 and 2016. Among them, 49 patients with clinical stage IIIB/N2 NSCLC were identified based on single-station, non-bulky N2 disease confirmed by invasive staging and anatomically resectable tumors. Patients were grouped by T stage and mediastinal downstaging status following neoadjuvant therapy. Survival outcomes were analyzed using Kaplan-Meier and Cox regression models.
The overall 5-year survival (OS) rate was 29.2% (median 23 months), and the 5-year disease-free survival (DFS) rate was 22.0% (median 12.4 months). While patients with non-invasive T3 tumors had better OS and DFS than those with invasive T3 or T4 tumors, the differences were not statistically significant. Mediastinal downstaging was associated with improved OS (p = 0.049). Multivariate analysis identified local tumor invasion (HR: 2.15, p = 0.045) and early postoperative complications (HR: 2.93, p = 0.011) as independent predictors of worse OS.
Surgical resection may be a viable option in highly selected cIIIB/N2 NSCLC patients-particularly those who respond well to neoadjuvant therapy and are anatomically resectable. However, tumor invasion and postoperative complications negatively affect survival. These findings underscore the importance of precise patient selection and perioperative management. Further prospective studies are needed to validate the role of surgery in this subset, especially in the context of evolving systemic therapies.
本研究评估手术在多模式治疗方法中对部分ⅢB/N2期非小细胞肺癌（NSCLC）患者的作用。我们重点关注纵隔降期、局部肿瘤侵犯及术后并发症对生存结局的影响。
对2010年至2016年间接受手术的1752例NSCLC患者进行回顾性分析。其中，49例临床ⅢB/N2期NSCLC患者基于经侵入性分期确认的单站、非巨大N2疾病及解剖学上可切除的肿瘤得以确定。患者根据新辅助治疗后的T分期和纵隔降期状态分组。使用Kaplan-Meier法和Cox回归模型分析生存结局。
总体5年生存率（OS）为29.2%（中位生存期23个月），5年无病生存率（DFS）为22.0%（中位生存期12.4个月）。非侵袭性T3肿瘤患者的OS和DFS优于侵袭性T3或T4肿瘤患者，但差异无统计学意义。纵隔降期与OS改善相关（p = 0.049）。多因素分析确定局部肿瘤侵犯（HR：2.15，p = 0.045）和术后早期并发症（HR：2.93，p = 0.011）是OS较差的独立预测因素。
手术切除对于经过严格筛选的cIIIB/N2期NSCLC患者可能是一种可行的选择，尤其是那些对新辅助治疗反应良好且在解剖学上可切除的患者。然而，肿瘤侵犯和术后并发症对生存有负面影响。这些发现强调了精确的患者选择和围手术期管理的重要性。需要进一步的前瞻性研究来验证手术在这一亚组中的作用，特别是在不断发展的全身治疗背景下。
