Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer
Abstract Objective This study evaluates the role of surgery in selected stage IIIB/N2 non-small cell lung cancer (NSCLC) patients within a multimodal treatment approach. We focused on the impact of mediastinal downstaging, local tumor invasion, and postoperative complications on survival outcomes. M...
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BMC
2025-07-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-025-03822-7 |
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| author | Mithat Fazlıoglu Volkan Erdogu Necati Citak Nevin Fazlıoglu Muzaffer Metin |
| author_facet | Mithat Fazlıoglu Volkan Erdogu Necati Citak Nevin Fazlıoglu Muzaffer Metin |
| author_sort | Mithat Fazlıoglu |
| collection | DOAJ |
| description | Abstract Objective This study evaluates the role of surgery in selected stage IIIB/N2 non-small cell lung cancer (NSCLC) patients within a multimodal treatment approach. We focused on the impact of mediastinal downstaging, local tumor invasion, and postoperative complications on survival outcomes. Methods A retrospective analysis was conducted on 1752 NSCLC patients who underwent surgery between 2010 and 2016. Among them, 49 patients with clinical stage IIIB/N2 NSCLC were identified based on single-station, non-bulky N2 disease confirmed by invasive staging and anatomically resectable tumors. Patients were grouped by T stage and mediastinal downstaging status following neoadjuvant therapy. Survival outcomes were analyzed using Kaplan-Meier and Cox regression models. Results The overall 5-year survival (OS) rate was 29.2% (median 23 months), and the 5-year disease-free survival (DFS) rate was 22.0% (median 12.4 months). While patients with non-invasive T3 tumors had better OS and DFS than those with invasive T3 or T4 tumors, the differences were not statistically significant. Mediastinal downstaging was associated with improved OS (p = 0.049). Multivariate analysis identified local tumor invasion (HR: 2.15, p = 0.045) and early postoperative complications (HR: 2.93, p = 0.011) as independent predictors of worse OS. Conclusions Surgical resection may be a viable option in highly selected cIIIB/N2 NSCLC patients—particularly those who respond well to neoadjuvant therapy and are anatomically resectable. However, tumor invasion and postoperative complications negatively affect survival. These findings underscore the importance of precise patient selection and perioperative management. Further prospective studies are needed to validate the role of surgery in this subset, especially in the context of evolving systemic therapies. |
| format | Article |
| id | doaj-art-203a1594f8d44363971d6d4ef3f74401 |
| institution | Kabale University |
| issn | 1471-2466 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj-art-203a1594f8d44363971d6d4ef3f744012025-08-20T03:42:43ZengBMCBMC Pulmonary Medicine1471-24662025-07-012511710.1186/s12890-025-03822-7Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancerMithat Fazlıoglu0Volkan Erdogu1Necati Citak2Nevin Fazlıoglu3Muzaffer Metin4Department of Thoracic Surgery, Tekirdag Namik Kemal University Medical FacultyDepartment of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery, Training and Research HospitalDepartment of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery, Training and Research HospitalDepartment of Pulmonology, Tekirdag Namik Kemal University Medical FacultyDepartment of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery, Training and Research HospitalAbstract Objective This study evaluates the role of surgery in selected stage IIIB/N2 non-small cell lung cancer (NSCLC) patients within a multimodal treatment approach. We focused on the impact of mediastinal downstaging, local tumor invasion, and postoperative complications on survival outcomes. Methods A retrospective analysis was conducted on 1752 NSCLC patients who underwent surgery between 2010 and 2016. Among them, 49 patients with clinical stage IIIB/N2 NSCLC were identified based on single-station, non-bulky N2 disease confirmed by invasive staging and anatomically resectable tumors. Patients were grouped by T stage and mediastinal downstaging status following neoadjuvant therapy. Survival outcomes were analyzed using Kaplan-Meier and Cox regression models. Results The overall 5-year survival (OS) rate was 29.2% (median 23 months), and the 5-year disease-free survival (DFS) rate was 22.0% (median 12.4 months). While patients with non-invasive T3 tumors had better OS and DFS than those with invasive T3 or T4 tumors, the differences were not statistically significant. Mediastinal downstaging was associated with improved OS (p = 0.049). Multivariate analysis identified local tumor invasion (HR: 2.15, p = 0.045) and early postoperative complications (HR: 2.93, p = 0.011) as independent predictors of worse OS. Conclusions Surgical resection may be a viable option in highly selected cIIIB/N2 NSCLC patients—particularly those who respond well to neoadjuvant therapy and are anatomically resectable. However, tumor invasion and postoperative complications negatively affect survival. These findings underscore the importance of precise patient selection and perioperative management. Further prospective studies are needed to validate the role of surgery in this subset, especially in the context of evolving systemic therapies.https://doi.org/10.1186/s12890-025-03822-7Stage IIIBN2Non-small cell lung cancerDownstagingSurgeryMultimodal treatment |
| spellingShingle | Mithat Fazlıoglu Volkan Erdogu Necati Citak Nevin Fazlıoglu Muzaffer Metin Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer BMC Pulmonary Medicine Stage IIIB N2 Non-small cell lung cancer Downstaging Surgery Multimodal treatment |
| title | Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer |
| title_full | Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer |
| title_fullStr | Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer |
| title_full_unstemmed | Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer |
| title_short | Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer |
| title_sort | surgery after neoadjuvant therapy in patients with resectable stage iiib n2 non small cell lung cancer |
| topic | Stage IIIB N2 Non-small cell lung cancer Downstaging Surgery Multimodal treatment |
| url | https://doi.org/10.1186/s12890-025-03822-7 |
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