Yamanashi Keiji, Hamaji Masatsugu, Miyata Ryo, Nakanobo Ryo, Kobayashi Masashi, Sonobe Makoto, Ikeda Masaki, Muranishi Yusuke, Kono Tomoya, Oda Hiromi, Yamagishi Hiroya, Yamada Yoshito, Shoji Tsuyoshi, Fukada Takehisa, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan.
J Thorac Dis. 2025 Aug 31;17(8):5524-5533. doi: 10.21037/jtd-2025-809. Epub 2025 Aug 11.
Current guidelines recommend chemoradiotherapy or chemotherapy alone in cases of prior radiotherapy for mediastinal lymph node (LN) recurrence after surgery for non-small cell lung cancer (NSCLC). However, data on management and outcomes remain limited. This study investigated treatment approaches and survival outcomes in patients with isolated ipsilateral hilar or mediastinal LN recurrence after surgical resection for NSCLC.
A retrospective chart review was conducted using a multi-institutional database to identify consecutive patients with isolated ipsilateral hilar or mediastinal LN recurrence after surgical resection for NSCLC between 2014 and 2016 at 10 institutions. Patient characteristics, recurrence treatment, and post-recurrence survival (PRS) were analyzed.
Sixty-seven patients were included, with a median age of 72 years and a median follow-up of 51.5 months. Two- and 5-year PRS rates were 69.2% and 34.2%, respectively. Local radical therapy (LRT) (surgical resection or radiotherapy), chemotherapy, and chemoradiotherapy were administered in 16 (24%), 30 (45%), and 21 (31%) patients, respectively. Among those receiving chemotherapy, cytotoxic drugs, tyrosine kinase inhibitor (TKI), and immune checkpoint inhibitor (ICI) with or without cytotoxic drugs were administered in 12, 11, and 7 patients, respectively. Five-year PRS rates in patients receiving LRT, chemotherapy, and chemoradiotherapy were 32.9%, 12.6%, and 55.0%, respectively.
Our data suggest that various treatments are administered for postoperative recurrence at isolated ipsilateral hilar or mediastinal LN, differing from current guideline recommendations, which is associated with acceptable survival outcomes. Multidisciplinary discussions are essential for optimizing management.
目前的指南建议，对于非小细胞肺癌（NSCLC）手术后纵隔淋巴结（LN）复发且既往接受过放疗的患者，采用单纯放化疗或化疗。然而，关于治疗管理和结局的数据仍然有限。本研究调查了NSCLC手术切除后孤立性同侧肺门或纵隔LN复发患者的治疗方法和生存结局。
使用多机构数据库进行回顾性病历审查，以确定2014年至2016年期间在10家机构接受NSCLC手术切除后孤立性同侧肺门或纵隔LN复发的连续患者。分析患者特征、复发治疗情况和复发后生存（PRS）情况。
纳入67例患者，中位年龄72岁，中位随访时间51.5个月。2年和5年PRS率分别为69.2%和34.2%。分别有16例（24%）、30例（45%）和21例（31%）患者接受了局部根治性治疗（LRT）（手术切除或放疗）、化疗和放化疗。在接受化疗的患者中，分别有12例、11例和7例接受了细胞毒性药物、酪氨酸激酶抑制剂（TKI）以及联合或不联合细胞毒性药物的免疫检查点抑制剂（ICI）治疗。接受LRT、化疗和放化疗的患者5年PRS率分别为32.9%、12.6%和55.0%。
我们的数据表明，对于孤立性同侧肺门或纵隔LN术后复发的患者，采用了多种不同的治疗方法，这与当前指南建议不同，但生存结局尚可。多学科讨论对于优化治疗管理至关重要。
