WCLC 2025 - Posters & ePosters-P2.08 .07 Lymph Node Yield and Survival Among Lung Cancer Patients Treated With Neoadjuvant Systemic Therapy

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This study evaluates the impact of lymph node yield on survival in patients with clinical stage II or III non-small cell lung cancer (NSCLC) treated with neoadjuvant systemic therapy, including chemotherapy, chemoradiotherapy, or chemoimmunotherapy. Using data from the National Cancer Database spanning 2010-2021, the authors analyzed 8,531 patients who underwent lung resection and stratified them by the number of pathologic lymph nodes removed: 0, 1-3, 4-9, or 10 or more nodes.<br /><br />Key cohort features included a median age of 64, nearly 47% female, over 70% with clinical stage III disease, nearly 50% receiving neoadjuvant chemoradiotherapy, and approximately 84% undergoing lobectomy procedures. The primary outcome was 3-year overall survival, analyzed through Cox proportional hazards modeling and propensity-matched Kaplan-Meier survival curves.<br /><br />Findings demonstrated that resection of 10 or more lymph nodes after neoadjuvant therapy was associated with a modest but notable survival advantage compared to lower nodal yields. Specifically, the 3-year overall survival for patients with ≥10 nodes removed was 65.9%, compared to 66.6% for 0 nodes, 58.2% for 1-3 nodes, and 62.2% for 4-9 nodes. Survival curves adjusted for confounders further supported improved outcomes with higher lymph node yields.<br /><br />These results reinforce that thorough lymph node sampling during lung cancer surgery remains important after preoperative systemic therapy, potentially improving staging accuracy and guiding adjuvant treatment decisions. Current guidelines suggest sampling at least four nodal stations, but examining 10 or more nodes may confer additional survival benefit. <br /><br />The authors highlight the need for further research to clarify the implications of lymph node yield after specific neoadjuvant therapies. This study contributes valuable insight into optimizing surgical and multimodal management of NSCLC in the neoadjuvant setting.

Asset Subtitle

Giorgio Caturegli

Meta Tag

Speaker Giorgio Caturegli

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

lymph node yield

non-small cell lung cancer

NSCLC

neoadjuvant systemic therapy

chemotherapy

chemoradiotherapy

chemoimmunotherapy

overall survival

lung resection

lymph node sampling