Related Experiment Video
Updated: Mar 9, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Neoadjuvant Chemoimmunotherapy Followed by Surgery or Radiotherapy for Stage IIIA-B Non-Small Cell Lung Cancer With
Suyu Wang1, Yifei Zhou1, Shiqi Hu2
1Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Background:
The optimal treatment for stage III non-small cell lung cancer (NSCLC) patients with bulky N2 disease remains controversial. This study evaluated the efficacy of neoadjuvant chemoimmunotherapy followed by surgery or radiotherapy in these patients.
Methods:
Patients diagnosed with stage III (N2) NSCLC with bulky N2 disease who received neoadjuvant chemoimmunotherapy between January 2019 and January 2023 at our institution were retrospectively reviewed. Kaplan-Meier curves and log-rank tests were used to analyze differences in event-free survival (EFS) and overall survival (OS) between the surgery and radiotherapy groups. Cox proportional hazards regression was applied to identify independent risk factors.
Results:
Included were 65 patients without disease progression after neoadjuvant chemoimmunotherapy: 43 (66.2%) underwent surgery and 22 (33.8%) received radiotherapy. The median follow-up time was 45.3 months. The 3-year EFS and OS rates for the entire cohort were 53.7% and 81.2%, respectively. In multivariable Cox regression analyses, the surgery group showed significantly longer EFS (hazard ratio, 0.15; P = .003) and OS (hazard ratio, 0.18; P = .046) than the radiotherapy group. R0 resection rate was 100%. The major and complete pathological response rates in the surgery group were 55.8% and 27.9%, respectively.
Conclusions:
Surgery is a feasible and effective consolidative strategy in a carefully selected subgroup of patients with bulky N2 disease who respond favorably to neoadjuvant chemoimmunotherapy.
