Survival impact of pN2a and pN2b nodal status in stage IIB-IIIB non-small cell lung cancer under the 9th TNM classification
Turkish Journal of Thoracic and Cardiovascular Surgery, cilt.34, sa.2, ss.207-212, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 34 Sayı: 2
- Basım Tarihi: 2026
- Doi Numarası: 10.4274/tjtcs.2026.2025-12-14
- Dergi Adı: Turkish Journal of Thoracic and Cardiovascular Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.207-212
- Anahtar Kelimeler: Lung cancer surgery, surgical outcomes, thoracic surgery, TNM staging
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Surgical resection in non-small cell lung cancer (NSCLC) is a potentially curative option in selected patients. Current TNM staging systems emphasize the prognostic role of pathological N (pN) status, and in the 9th TNM system pN2 disease is subdivided into single- (pN2a) and multiple-station (pN2b) N2 involvement. This study aimed to evaluate the impact of nodal status and other prognostic factors on survival in patients with stage IIB–IIIB NSCLC reclassified according to the 8th and 9th TNM systems. Methods: A total of 824 patients aged ≥18 years who underwent lung resection for NSCLC between 2007 and 2021 and were stage IIB, IIIA, or IIIB according to the 8th TNM system were included. Demographic, histopathologic, surgical, and survival data were retrospectively analyzed. All cases were restaged according to both the 8th and 9th TNM criteria, and the effects of lymph node status and pathological factors on survival were investigated. Results: The mean age was 59.7±8.58 years; 10.4% of patients were female. Squamous cell carcinoma (61.7%) and adenocarcinoma (32.5%) were the most common histologies. Lobectomy, pneumonectomy, and segmentectomy were performed in 52.3%, 46.8%, and 0.8% of patients, respectively. Age >70 years (p<0.001) and adenocarcinoma histology (p<0.001) were associated with worse survival, whereas gender and type of resection were not. pN2 disease had significantly worse survival than pN1 (p<0.001). In the 9th TNM system, pN2b had worse survival than pN1 and pN2a (p<0.001), while pN1 and pN2a did not differ significantly (p=0.088). Stage IIA/IIB patients had better survival than those with more advanced stages (p<0.001).