ArticleAmerican journal of cancer research2026
Comparative effectiveness of different adjuvant therapy modalities for stage IIIA-N2 non-small cell lung cancer following complete resection: a retrospective analysis.
Article in American journal of cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe optimal adjuvant strategy for completely resected stage IIIA-N2 non-small cell lung cancer (NSCLC) remains debated. While adjuvant chemotherapy (ACT) is standard, the added value of radiotherapy (RT) - and the optimal modality of integration (concurrent [ACRT] vs. sequential [ACT+RT]) - are uncertain. This study compared the long-term effectiveness of different adjuvant modalities.
methodsIn this single-center retrospective cohort study, 247 patients with completely resected (R0) pathological stage IIIA-N2 NSCLC (2015-2020) were categorized by treatment received: Observation (n=37), ACT (n=86), ACRT (n=53), or ACT+RT (n=71). Primary endpoints were overall survival (OS) and disease-free survival (DFS). Multivariable Cox regression adjusted for key confounders (e.g., N2 station number, extracapsular extension).
resultsWith median follow-up of 52.3 months, multivariable analysis showed ACRT (HR=0.41, 95% CI: 0.26-0.64), ACT+RT (HR=0.49, 95% CI: 0.32-0.75), and ACT (HR=0.66, 95% CI: 0.44-0.99) were independently associated with improved OS versus Observation (all P<0.05). For DFS, all active treatments were superior to Observation; ACRT showed a trend over ACT alone (HR=0.43 vs. 0.63). OS and DFS did not differ significantly between ACRT and ACT+RT. The ACRT group had the highest locoregional control (failure rate: 17.0% vs. 22.1-27.0% in others) but also the highest grade ≥3 toxicity (54.7%, primarily radiation esophagitis/pneumonitis), while ACT+RT had lower toxicity (39.4%).
conclusionFor completely resected stage IIIA-N2 NSCLC, adjuvant regimens incorporating radiotherapy (ACRT or ACT+RT) are associated with superior survival outcomes compared to ACT alone or observation. The comparable efficacy but more favorable toxicity profile of the sequential approach suggests it may be a viable option, particularly for patients at risk for additive toxicities. These real-world discoveries provide a basis for the local systemic combined treatment of the high-risk population.
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