Abstract
OBJECTIVE: Stage IIIA (N2) non-small cell lung cancer (NSCLC) treatment can depend on the extent of nodal involvement, with surgery considered for limited disease and definitive chemoradiation preferred for bulky or multi-station disease. Evidence to support management is limited. This study evaluated the impact of the extent of stage IIIA (N2) nodal involvement on outcomes after surgery. METHODS: Patients who underwent surgical resection of T1-2N2M0 NSCLC in the Surveillance, Epidemiology, and End Results database from 2004 to 2019 were stratified as having limited (1 positive node) versus more extensive (>1 positive node) nodal disease, and survival was evaluated with Kaplan-Meier and Cox analyses. RESULTS: Of the 6933 patients identified surgical patients, 2129 (30.7%) had limited nodal disease whereas 4804 (69.3%) had more extensive nodal involvement. The limited nodal group had greater 5-year overall survival than the more extensive node group (39.3% vs 30.3%, P < .001), and more extensive nodal involvement (hazard ratio, 1.26; P < .001) was independently associated with worse survival in Cox analysis. Surgical patients had a greater 5-year overall survival than 1644 comparable N2 patients with extensive nodal involvement who received definitive chemoradiation (30.9% vs 18.9%, P < .001). CONCLUSIONS: Increasing nodal involvement is associated with worse survival for patients with stage IIIA (N2) NSCLC but select patients with more extensive nodal disease may still benefit from surgery compared to chemoradiation.