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Purpose <p>Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease that requires tailored treatment strategies. This study investigates the correlation between T and N factors and postoperative recurrence patterns to refine therapeutic approaches.</p> Methods <p>The subjects of this retrospective cohort study were 193 patients with LA-NSCLC, who underwent trimodality therapy between 1999 and 2021. Tumors were categorized as Nodal-Dominant (ND) LA-NSCLC (T1-2 with advanced nodal involvement) or Tumor-Dominant (TD) LA-NSCLC (T3-4 with limited nodal involvement). We compared recurrence patterns and survival outcomes between the two groups.</p> Results <p>The 193 patients comprised 83 with ND-LA-NSCLC and 110 with TD-LA-NSCLC. The patients with ND-LA-NSCLC had a significantly higher rate of distant metastasis than those with TD-LA-NSCLC (50.6% vs. 26.4%, <i>P</i> = 0.001). The patients with TD-LA-NSCLC had significantly better 5-year disease-free survival (DFS) than those with ND-LA-NSCLC (62.4% vs. 37.2%, <i>P</i> &lt; 0.001).</p> Conclusions <p>ND-LA-NSCLC is associated with a higher risk of distant metastatic recurrence, underscoring the need for more effective systemic therapies before surgery. Conversely, TD-LA-NSCLC exhibits superior local disease control, reinforcing the role of intensive local therapies. These findings emphasize the importance of tumor classification based on T and N factors for optimizing perioperative treatment strategies for LA-NSCLC.</p>

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Distinct recurrence patterns related to preoperative treatment decisions for patients with locally advanced non-small cell lung cancer

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Kazuhiro Okada,
  • Ken Suzawa,
  • Tsuyoshi Ryuko,
  • Anna Rogachevskaya,
  • Yusuke Otani,
  • Yasuaki Tomioka,
  • Shin Tanaka,
  • Hidejiro Torigoe,
  • Kazuhiko Shien,
  • Kentaroh Miyoshi,
  • Mikio Okazaki,
  • Seiichiro Sugimoto,
  • Shinichi Toyooka

摘要

Purpose

Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease that requires tailored treatment strategies. This study investigates the correlation between T and N factors and postoperative recurrence patterns to refine therapeutic approaches.

Methods

The subjects of this retrospective cohort study were 193 patients with LA-NSCLC, who underwent trimodality therapy between 1999 and 2021. Tumors were categorized as Nodal-Dominant (ND) LA-NSCLC (T1-2 with advanced nodal involvement) or Tumor-Dominant (TD) LA-NSCLC (T3-4 with limited nodal involvement). We compared recurrence patterns and survival outcomes between the two groups.

Results

The 193 patients comprised 83 with ND-LA-NSCLC and 110 with TD-LA-NSCLC. The patients with ND-LA-NSCLC had a significantly higher rate of distant metastasis than those with TD-LA-NSCLC (50.6% vs. 26.4%, P = 0.001). The patients with TD-LA-NSCLC had significantly better 5-year disease-free survival (DFS) than those with ND-LA-NSCLC (62.4% vs. 37.2%, P < 0.001).

Conclusions

ND-LA-NSCLC is associated with a higher risk of distant metastatic recurrence, underscoring the need for more effective systemic therapies before surgery. Conversely, TD-LA-NSCLC exhibits superior local disease control, reinforcing the role of intensive local therapies. These findings emphasize the importance of tumor classification based on T and N factors for optimizing perioperative treatment strategies for LA-NSCLC.