Background: Stage IIIA-N2 non-small cell lung cancer (NSCLC) poses a significant clinical challenge, with low survival rates despite advances in therapy. The lack of a standardised treatment approach complicates patient management. This study utilises real-world data from Guy’s Thoracic Cancer Database to analyse patient outcomes, identify key predictors of overall survival (OS) and disease-free survival (DFS), and address the limitations of randomised controlled trials. Methods: This observational, single-centre, non-randomised study analysed 142 patients diagnosed with clinical and pathological T1/2 N2 NSCLC who received curative treatment from 2015 to 2021. Patients were categorised into three groups: Group A (30 patients) underwent surgery for clinical N2 disease, Group B (54 patients) had unsuspected N2 disease discovered during surgery, and Group C (58 patients) received radical chemoradiation or radiotherapy alone (CRT/RT) for clinical N2 disease. Data on demographics, treatment types, recurrence, and survival rates were analysed. Results: The median OS for the cohort was 31 months, with 2-year and 5-year OS rates of 60% and 30%, respectively. Group A had a median OS of 32 months, Group B 36 months, and Group C 25 months. The median DFS was 18 months overall, with Group A at 16 months, Group B at 22 months, and Group C at 17 months. Significant predictors of OS included ECOG performance status, lymphovascular invasion, and histology. No significant differences in OS were found between treatment groups (p= 0.99). Conclusions: This study highlights the complexity and diversity of Stage IIIA-N2 NSCLC, with no single superior treatment strategy identified. The findings underscore the necessity for personalised treatment approaches and multidisciplinary decision-making. Future research should focus on integrating newer therapeutic modalities and conducting multi-centre trials to refine treatment strategies. Collaboration and ongoing data collection are crucial for improving personalised treatment plans and survival outcomes for Stage IIIA-N2 NSCLC patients.
背景：IIIA-N2期非小细胞肺癌（NSCLC）是临床治疗中的重大挑战，尽管治疗方法有所进展，但患者生存率仍然较低。缺乏标准化的治疗方案使患者管理更为复杂。本研究利用盖伊医院胸科癌症数据库的真实世界数据，分析患者预后，确定总生存期（OS）和无病生存期（DFS）的关键预测因素，并探讨随机对照试验的局限性。 方法：这项观察性、单中心、非随机研究分析了2015年至2021年间诊断为临床及病理T1/2 N2期NSCLC并接受根治性治疗的142例患者。患者分为三组：A组（30例）为临床N2期患者接受手术治疗，B组（54例）为术中意外发现N2期病变的患者，C组（58例）为临床N2期患者接受根治性放化疗或单纯放疗（CRT/RT）。研究分析了人口统计学特征、治疗类型、复发情况及生存率等数据。 结果：全队列患者的中位OS为31个月，2年和5年OS率分别为60%和30%。A组中位OS为32个月，B组为36个月，C组为25个月。全队列中位DFS为18个月，其中A组为16个月，B组为22个月，C组为17个月。OS的显著预测因素包括ECOG体能状态、淋巴血管侵犯和组织学类型。各治疗组间的OS无显著差异（p=0.99）。 结论：本研究揭示了IIIA-N2期NSCLC的复杂性和多样性，未发现单一优势治疗策略。研究结果强调了制定个体化治疗方案和多学科决策的必要性。未来研究应聚焦于整合新型治疗模式并开展多中心试验，以优化治疗策略。加强协作和持续数据收集对于改善IIIA-N2期NSCLC患者的个体化治疗计划和生存预后至关重要。
Real-World Analysis of Survival and Treatment Efficacy in Stage IIIA-N2 Non-Small Cell Lung Cancer
肿瘤(癌症)患者之家