Prognostic factors for recurrence-free survival in resected pathologic N2-stage III non-small cell lung cancer treated with upfront surgery

Q: What patient group and treatment strategy were evaluated in this study?

The study evaluated selected patients with resectable pathologic N2-stage III NSCLC treated with upfront anatomical resection at Taipei Veterans General Hospital.

Q: How were prognostic factors for recurrence-free survival (RFS) identified?

Clinicopathologic characteristics were retrospectively reviewed, and a Cox regression model was used to identify prognostic factors of RFS.

Q: Which factor was significantly associated with RFS in the multivariable analysis?

A tumor size greater than 3 cm was the significant predictor for RFS, with a hazard ratio of 1.74 (95% CI 1.07–2.83, p=0.027).

Sep 29, 2026

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Standard management for pathological N2 (pN2) non-small-cell lung cancer (NSCLC) is definitive chemoradiation, yet surgery may benefit resectable disease. This retrospective study reviewed pN2 NSCLC patients receiving upfront anatomical resection at Taipei Veterans General Hospital from 2011 to 2019. Cox regression assessed recurrence-free survival (RFS) predictors. Among 84 patients, 1-, 3-, and 5-year RFS rates were 63.1%, 31.3%, and 19.9%; tumor size >3 cm independently predicted worse RFS.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Abstract

1. INTRODUCTION

2. METHOD

2.1. Study design and eligibility criteria

J Chin MedAssoc Original article Prognostic factors for recurrence-free survival in resected pathologic N2-stage III non-small cell lung cancer treated with upfront surgery Ping-Chung Tsaia,b, Chia Liuc, Yi-Chen Yehd, Po-Kuei Hsub,c, Chien-Sheng Huangb,c, Chih-Cheng Hsiehb,c, Han-Shui Hsub,c,* aDivision of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; bDepartment of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDivision of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: The standard treatment for pathological N2 (pN2) non-small-cell lung cancer (NSCLC) patients is definitive chemoradiation. Surgery might be beneficial for resectable pN2 disease, so we investigated the recurrence-free interval of upfront surgery for selected patients with resectable pN2 disease. Methods: The clinicopathologic characteristics of patients with pN2 NSCLC who underwent upfront anatomical resection at Taipei Veterans General Hospital from 2011 January to 2019 December were retrospectively reviewed. A Cox regression model was used to identify prognostic factors of recurrence-free survival (RFS) . Results: In total, 84 patients after curative lung anatomic resection were analyzed, with a 44-month median survival. The 1- , 3- , and 5-year RFS rates were 63. 1%, 31.3%, and 19.9%, respectively, with a median RFS of 18.9 months. Multivariable cox regression analysis identified that the significant predictor for RFS was a tumor size of more than 3 cm (hazard ratio [HR] = 1.74, 95% CI, 1.07-2.83, p = 0 .027) . Visceral pleural invasion, LN harvest number, tumor stage, and N2 status including single zone (N2a) or multiple zones (N2b) were not prognostic factors in this study. Conclusion: Upfront surgery for resectable N2 disease achieved favorable outcomes in selected patients, especially better recurrence control with limited tumor size. Therapeutic advances might encourage surgeons to aggressive intervention. Keywords: Local advanced lung cancer; N2-stage III disease; Upfront surgery 1. INTRODUCTION Patients with non-small-cell lung cancer (NSCLC), a disease involving the ipsilateral mediastinum (N2), are embodied by a spectrum of disease states. The presence of N2 metastasis indicates a dismal prognosis and high risk of relapse, with 5-year overall survival (OS) rates <35% .1 Concurrent chemoradiotherapy is recommended for unresectable or bulky N2 disease2 but potentially resectable N2 disease may be treated by neoadjuvant chemotherapy followed by surgery,2 even without radiotherapy.3 According to a Cardiothoracic Surgery Network survey,4 an overwhelming number of respondents * Address correspondence. Dr. Han-Shui Hsu, Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: hsuhs@vghtpe.gov.tw](ROC. E-mail address: hsuhs@vghtpe.gov.tw) (H.-S. Hsu). Conflicts of interest: Dr. Han-Shui Hsu, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2024) 87: 212-218. Received February 21, 2023; accepted December 15, 2023. doi: 10. 1097/JCMA.0000000000001050 Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) (84%) would choose neoadjuvant chemoradiation followed by surgical rese

FAQs

What patient group and treatment strategy were evaluated in this study?

The study evaluated selected patients with resectable pathologic N2-stage III NSCLC treated with upfront anatomical resection at Taipei Veterans General Hospital.

How were prognostic factors for recurrence-free survival (RFS) identified?

Clinicopathologic characteristics were retrospectively reviewed, and a Cox regression model was used to identify prognostic factors of RFS.

Which factor was significantly associated with RFS in the multivariable analysis?

A tumor size greater than 3 cm was the significant predictor for RFS, with a hazard ratio of 1.74 (95% CI 1.07–2.83, p=0.027).

Sep 29, 2026

Uploaded by Ivy