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Impact of the number of involved lymph node zones on survival in stage IIIA-N2 lung adeno and squamous cell carcinoma

OBJECTIVES The role of upfront surgery in treating stage IIIA-N2 non-small cell lung cancer remains controversial. This study aimed to evaluate the role of upfront surgery in selected patients with stage IIIA-N2 and assess the prognostic significance of the number of involved lymph node zones in rel...

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Main Authors: Griffo, Raffaella (Author) , Hoffmann, Hans (Author) , Safi, Seyer (Author) , Eichhorn, Florian (Author) , Klotz, Laura Valentina (Author) , Muley, Thomas (Author) , Baum, Philip (Author) , Kriegsmann, Mark (Author) , Bischoff, Helge (Author) , Winter, Hauke (Author) , Eichhorn, Martin E. (Author)
Format: Article (Journal)
Language:English
Published: June 2025
In: Interdisciplinary cardiovascular and thoracic surgery
Year: 2025, Volume: 40, Issue: 6, Pages: 1-10
ISSN:2753-670X
DOI:10.1093/icvts/ivaf121
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/icvts/ivaf121
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Author Notes:Raffaella Griffo, Hans Hoffmann, Seyer Safi, Florian Eichhorn, Laura Klotz, Thomas Muley, Philip Baum, Marc Kriegsmann, Helge Bischoff, Hauke Winter and Martin E. Eichhorn
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Summary:OBJECTIVES The role of upfront surgery in treating stage IIIA-N2 non-small cell lung cancer remains controversial. This study aimed to evaluate the role of upfront surgery in selected patients with stage IIIA-N2 and assess the prognostic significance of the number of involved lymph node zones in relation to the N2-subclassification proposed by the International Association for the Study of Lung Cancer, comparing adenocarcinoma and squamous cell carcinoma.METHODS We retrospectively analysed patients with pIIIA-N2 adeno- or squamous cell carcinoma who underwent complete surgical resection with zone-based lymph node dissection. Survival was calculated using the Kaplan-Meier method, and group differences were assessed via log-rank test and Cox regression analysis.RESULTS A total of 222 patients were analysed. The 5-year overall survival rate was 43%, with a median overall survival of 47.2 months. In the adenocarcinoma cohort, the N2b-subgroup was associated with a 1.7-fold increased risk of death, whereas adjuvant chemotherapy reduced the risk by 41%. In squamous cell carcinoma, neither adjuvant chemotherapy nor the N2b-subgroup were identified as prognostic factors for overall survival.CONCLUSIONS The zone concept for intraoperatively assigning lymph nodes and the proposed N2-subgroups allowed a good stratification of long-term survival in patients with adenocarcinoma. The role of surgery in the treatment of non-small cell lung cancer (NSCLC) stage IIIA-N2 is one of the most rigorously debated controversies [1, 2].
Item Description:Veröffentlicht: 27 May 2025
Gesehen am 21.10.2025
Physical Description:Online Resource
ISSN:2753-670X
DOI:10.1093/icvts/ivaf121

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