Abstract
ObjectivesStage IIIA(N2) non-small cell lung cancer (NSCLC) treatment can depend on the extent of nodal involvement, with surgery considered for limited disease and definitive chemoradiation preferred for bulky or multi-station disease. Evidence to support management is limited. This study evaluated the impact of the extent of Stage IIIA(N2) nodal involvement on outcomes after surgery. MethodsPatients who underwent surgical resection of T1-2N2M0 NSCLC in the Surveillance, Epidemiology, and End Results (SEER) database from 2004-2019 were stratified as having limited (1 positive node) versus more extensive (>1 positive node) nodal disease, and survival was evaluated with Kaplan-Meier and Cox analyses. ResultsOf the 6,933 patients identified surgical patients, 2,129 (30.7%) had limited nodal disease while 4,804 (69.3%) had more extensive nodal involvement. The limited nodal group had higher 5-year overall survival than the more extensive node group (39.3% vs 30.3%, p<0.001), and more extensive nodal involvement (Hazard Ratio 1.26, p<0.001) was independently associated with worse survival in Cox analysis. Surgical patients had a higher 5-year overall survival than 1,644 comparable N2 patients with extensive nodal involvement who received definitive chemoradiation (30.9% vs 18.9%, p<0.001). ConclusionsIncreasing nodal involvement is associated with worse survival for Stage IIIA(N2) NSCLC patients but select patients with more extensive nodal disease may still benefit from surgery compared to chemoradiation.
Published Version
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