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Background We investigated the effect of unexpected N2 on survival in stage IIIB/N2 cases.Methods We retrospectively analyzed 1803 non-small cell lung cancer patients between 2010 and 2016. There were 89 patients (4.9%) with unexpected N2 (pathological (p) IIIB/N2 group), whereas 49 patients (2.7%) with cN2 (clinical (c) IIIB/N2 group). Although pIIIB/N2 group underwent surgery followed by adjuvant therapy, the cIIIB/N2 group of patients had multimodality treatment including induction chemotherapy ± radiotherapy followed by surgery.Results The five-year overall survival (OS) for all patients was 36.0% [median survival time (MST) 27.9 months], and disease-free survival (DFS) was 28.9% (MST, 18.2 months). The OS was 39.6% (MST: 34.4 months) and the median DFS time was 31.1% (Median: 23.1 months) in the pIIIB/N2 group, whereas it was 29.2% (MST: 23.0 months) for OS and 22% (median: 12.4 months) for DFS in the cIIIB/N2 group. There were no significant OS and DFS differences between the pIIIB/N2 group and the cIIIB/N2 group (p= 0.124 and p= 0.168, respectively).Conclusions In stage IIIB/N2 cases, the fact that N2 could not be detected preoperatively with minimally invasive or invasive methods and was detected in the pathological examination after surgery does not provide a survival advantage.

AbstractBackgroundThe aim of this study was to evaluate the effect of prognostic factors and lymph node ratio (LNR) on survival in patients with resected non-small-cell lung cancer (NSCLC).MethodsData from 421 patients with NSCLC who underwent complete resection between 2009 and 2015 were evaluated retrospectively. LNR was defined as the ratio of positive lymph nodes to the total number of lymph nodes removed. Associations between overall survival (OS) and LNR, node (N) status, and histopathologic status were evaluated.ResultsThe 5-year survival rate was 42.5% among all patients and 26.6% for patients aged 65 years or older. In the multivariate analysis, age ≥65 years, advanced-stage disease, non-squamous cell carcinomas, pN status, and having multiple-station pN2 and multiple-station pN1 disease were found to be poor prognostic factors (p < 0.05). There was no statistical difference in survival between patients with LNR (hazard ratio: 1.04, p = 0.45).ConclusionThe results of our study indicate that pN stage, histopathologic type, pT stage, and geriatric age were the most important poor prognostic factors associated with survival after NSCLC resection. Although LNR is a factor associated with survival in gastrointestinal cancers, it did not impact survival in our study.