Prognostic Significance of the Uncertain Resection Based on the Extent of Nodal Dissection in Non-small-Cell Lung...

Our objective was to investigate the impact of complete resection (R0)/uncertain resection [R(un)] according to the extent of nodal dissection on overall survival (OS) and disease-free survival (DFS) in patients with non-small-cell lung cancer (NSCLC).

In total, 3783 patients with primary NSCLC receiving R0/R(un) between 2001 and 2014 were included, and those with the greatest mediastinal lymph node metastasis, operative death, or sublobar resection were excluded. Propensity score matching (PSM) was performed to minimize selection bias. The Kaplan-Meier method and Cox proportional hazards model were applied to assess the prognostic impact of R(un).

R0 patients had better OS and DFS than R(un) patients before and after PSM, with survival differences observed across all clinical and pathological stages (all P < 0.05). However, among patients with tumors ≤2 cm, no significant survival difference was observed (all P > 0.05). OS (P = 0.583) and DFS (P = 0.904) were comparable among P-stage N1 patients with R(un) and p-stage N2 patients with R0. Among patients receiving adjuvant chemotherapy, R(un) patients still had a poorer OS than R0 patients (P = 0.016). In contrast, for patients receiving adjuvant targeted therapy, the OS was comparable between groups (P = 0.577).

R(un) is an independent prognostic factor associated with poorer OS and DFS in NSCLC, except in cases involving tumors ≤2 cm. Patients with R(un) should be considered for upstaging to enable more accurate prognosis prediction. Adjuvant targeted therapy may mitigate the adverse prognostic effects of R(un).