Prognostic Factors and Survival in Surgically Treated Stage III Non-Small Cell Lung Cancer: A Real-World...

Background: Stage III non-small cell lung cancer (NSCLC) represents a clinically and biologically heterogeneous disease group, posing challenges in treatment standardization. Objective: This study aimed to evaluate survival outcomes and prognostic factors in patients with pathological stage III NSCLC undergoing upfront surgery in a real-world setting. Methods: Patients treated between January 2009 and December 2023 were retrospectively analyzed. All patients underwent anatomical resection with systematic mediastinal lymph node dissection and achieved complete (R0) resection. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and prognostic factors were evaluated using Cox proportional hazards regression. Nomograms were developed for individualized survival prediction. Results: A total of 390 patients were included, with a median follow-up of 35 months. The median OS was 47 months, and the median RFS was 30 months. Multivariable analysis identified age, PET-detected mediastinal nodal involvement, tumor location, postoperative complications, pathological nodal status, adjuvant chemotherapy, and adjuvant radiotherapy as independent predictors of OS (p = 0.001, p = 0.029, p = 0.006, p =0.002, p = 0.009, and 0.004, respectively), while adjuvant chemotherapy was associated with improved survival (p = 0.010). For RFS, pathological N2b disease, stage IIIB, tumor location, and adenocarcinoma histology were independent predictors (p = 0.001, p = 0.016, p = 0.029, and p = 0.027, respectively). The OS nomogram demonstrated moderate discriminative ability, whereas the RFS model showed limited predictive performance. Conclusions: These findings highlight the substantial heterogeneity of stage III NSCLC and emphasize the importance of individualized, multidisciplinary treatment strategies beyond conventional staging systems.