ArticleGeneral thoracic and cardiovascular surgery2026
Upfront surgery for clinical single-station N2 non-small cell lung cancer: real-world outcomes and implications for perioperative strategy.
Article in General thoracic and cardiovascular surgery, 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
objectiveAlthough neoadjuvant chemoimmunotherapy is increasingly adopted, the optimal treatment strategy for patients with clinical single-station N2 (cN2a) non-small cell lung cancer (NSCLC) remains controversial in real-world practice.
methodsWe retrospectively analyzed patients with cN2a NSCLC who underwent upfront surgery between 2007 and 2022. Surgical details, pathological staging, adjuvant treatment, and outcomes were assessed.
resultsFifty-three patients were included. Concordance between clinical and pathologic nodal status (cN2a vs. pN2a) was observed in 39.6% of patients; 35.8% were downstaged, and 24.5% were upstaged to multi-station N2 (pN2b). Median overall survival and recurrence-free survival (RFS) were 60.1 and 25.6 months. Among patients with pathologic N2 disease, recurrence or death within 1 year occurred in 42.8% of those with pN2a and 76.9% with pN2b, primarily due to distant metastases. Adjuvant chemotherapy was administered to 50.9% of the patients. In patients with pN2a, median RFS was 57.8 and 25.3 months with and without adjuvant chemotherapy, respectively (p = 0.916). In patients with pN2b, median RFS was 9.7 and 3.5 months, respectively (p = 0.104).
conclusionsUpfront surgery remains a feasible approach for carefully selected patients with cN2a NSCLC. However, high early recurrence rates, even after adjuvant chemotherapy, highlight the need for more effective perioperative systemic control.
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