Patients with stage III NSCLC with N2 lymph node involvement carry a complex and diverse disease entity. Challenges persist in the areas of diagnosis, staging, multimodal management, and the determination of surgical indications and resectability criteria. Therefore, this review focuses on the latest updates in N2 disease staging and its prognostic and treatment implications. Emphasis is placed on the importance of accurate staging using imaging modalities such as [18F]FDG-PET/CT as well as minimally invasive mediastinal staging endoscopic techniques. The evolving role of surgery in the management of N2 disease is also explored. The benefits of neoadjuvant and adjuvant treatments have been demonstrated, along with the efficacy of a combined multimodal approach with chemo-immunotherapy in the perioperative setting, reigniting the debate of N2 disease subsets and optimal treatment options. Furthermore, this review addresses the controversies surrounding surgical approaches in upfront “borderline” resectable stage III NSCLC as well as the benefits of combined chemoradiotherapy with consolidation immunotherapy for patients with unresectable tumors. In conclusion, personalized diagnostic and treatment approaches tailored to individual patient characteristics, resource availability, and institutional expertise are essential for optimizing outcomes in patients with stage III-N2 NSCLC.
伴有N2淋巴结受累的III期非小细胞肺癌患者构成一个复杂且异质性的疾病群体。在诊断、分期、多模式管理以及手术指征与可切除性判定方面仍存在诸多挑战。因此，本文综述聚焦于N2疾病分期的最新进展及其对预后和治疗的影响，重点强调采用[18F]FDG-PET/CT等影像学方法与微创纵隔分期内镜技术进行精准分期的重要性，同时探讨外科手术在N2疾病治疗中不断演变的角色。新辅助与辅助治疗的获益已获证实，围手术期化疗-免疫联合多模式治疗的疗效重新引发了关于N2疾病亚型分类与最佳治疗策略的讨论。此外，本文还探讨了初始“临界”可切除III期非小细胞肺癌手术方式的争议，以及不可切除肿瘤患者接受放化疗联合巩固免疫治疗的获益。总之，根据患者个体特征、医疗资源可及性及机构专业优势制定个体化诊疗策略，对优化III期N2非小细胞肺癌患者的临床结局至关重要。
肿瘤(癌症)患者之家