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Journals / Turkish Journal of Clinics and Laboratory / 2026 / Sayı: 1

Neoadjuvant chemotherapy with surgery versus concurrent chemoradiation in N2 non-small cell lung cancer: a retrospective comparative analysis of treatment outcomes

N2 lenf nodu tutulumu olan küçük hücreli dışı akciğer kanserinde neoadjuvan kemoterapi sonrası cerrahi ile eşzamanlı kemoradyoterapinin karşılaştırılması: Tedavi sonuçlarının retrospektif analizi

Doğan Bayram(Gülhane Eğitim ve Araştırma Hastanesi, Tıbbi Onkoloji Bölümü)0000-0002-5976-2494
Berkan Karabuga(SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA DR. ABDURRAHMAN YURTASLAN ONKOLOJİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ)0000-0001-5357-7610
Emre Hafızoğlu(AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, TIBBİ ONKOLOJİ BİLİM DALI)0000-0001-6291-851X
Ömer Faruk Köksal(Ankara Bilkent Şehir Hastanesi, İç Hastalıklar Bölümü)0009-0003-4278-0455
Mutlu Dogan(SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA DR. ABDURRAHMAN YURTASLAN ONKOLOJİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ)0000-0001-9359-3770
Efnan Algın(Ankara Bilkent Şehir Hastanesi , Tıbbi Onkoloji Bölümü)0000-0002-8917-9267
Dogan Uncu(ANKARA ŞEHİR HASTANESİ TIBBİ ONKOLOJİ BÖLÜMÜ)0000-0002-0929-3271
Öznur Bal(ANKARA ŞEHİR HASTANESİ TIBBİ ONKOLOJİ BÖLÜMÜ)0000-0002-6901-2646
Pages
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Publication Date
2026-02-26
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Overall survival (OS), event free survival (EFS), and prognostic factors were compared using Kaplan-Meier analysis and Cox proportional hazards modeling.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: The most effective management approach for non–small cell lung cancer (NSCLC) patients presenting with mediastinal (N2) lymph node involvement has not yet been clearly established.
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Key Findings & Data:This study compared clinical outcomes between neoadjuvant chemotherapy followed by surgical resection (NACTx-Surgery) and definitive concurrent chemoradiation (CRT) in patients with N2 disease.
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Conclusion & Impact:Overall survival (OS), event free survival (EFS), and prognostic factors were compared using Kaplan-Meier analysis and Cox proportional hazards modeling.
🔬Design:Modeling & Simulation
📍Scope:Comprehensive Sample
⚙️Variables:N2 lenf nodu hastalığı · mediastinal tutulum · neoadjuvan kemoterapi

Abstract

Aim: The most effective management approach for non–small cell lung cancer (NSCLC) patients presenting with mediastinal (N2) lymph node involvement has not yet been clearly established. This study compared clinical outcomes between neoadjuvant chemotherapy followed by surgical resection (NACTx-Surgery) and definitive concurrent chemoradiation (CRT) in patients with N2 disease. Methods: In this retrospective cohort analysis, we evaluated 61 individuals diagnosed with N2 stage NSCLC who received treatment at two high level tertiary care institutions. Thirty one patients received NACTx-surgery, and 30 patients received definitive CRT. Overall survival (OS), event free survival (EFS), and prognostic factors were compared using Kaplan-Meier analysis and Cox proportional hazards modeling. Results: The NACTx-surgery group achieved significantly superior median OS (37.9 months vs. 26.8 months; p=0.031) compared with the CRT group. EFS showed a trend toward improvement with NACTx-surgery (median 21.4 months vs. 13.9 months; p=0.052). TNM stage emerged as an independent predictor of EFS in multivariable analysis (HR 0.48; p=0.03). Recurrence occurred in 54.8% of NACTx-surgery patients and 70.0% of CRT patients. Conclusions: For appropriately selected patients with resectable N2 NSCLC, multimodal NACTx-surgery approaches achieved superior survival outcomes compared with definitive CRT. These findings support aggressive pursuit of resectability assessment and multimodal therapeutic planning. Future prospective randomized trials comparing contemporary NACTx-surgery with modern CRT plus consolidation immunotherapy are needed.

Özet

Amaç: Mediastinal (N2) lenf nodu tutulumu olan küçük hücreli dışı akciğer kanseri (KHDAK) hastalarında optimal tedavi stratejisi henüz yeterince tanımlanmamıştır. Bu çalışma, N2 hastalığı olan hastalarda neoadjuvan kemoterapi sonrası cerrahi rezeksiyonu (NAKT-Cerrahi) ile definitif eşzamanlı kemoradyoterapiyi (KRT) karşılaştırmıştır. Gereç ve Yöntemler: Bu retrospektif kohort çalışması iki onkoloji merkezinde tedavi gören N2 KHDAK'li 61 hastayı analiz etmiştir. Otuz bir hasta NAKT sonrası cerrahi aldı, 30 hasta ise definitif KRT aldı. Genel sağkalım (OS), nüks/progresyonsuz sağkalım (EFS) ve prognostik faktörler Kaplan Meier analizi ve Cox orantılı hazard modellemesi kullanılarak karşılaştırıldı. Sonuçlar: NAKT Cerrahi grubu KRT grubuna kıyasla anlamlı şekilde daha yüksek median OS (37,9 ay'a karşı 26,8 ay; p = 0,031) elde etmiştir. Nüks/progresyonsuz sağkalım NAKT- Cerrahi yaklaşımında iyileşme eğilimi göstermiştir (median 21,4 ay'a karşı 13,9 ay; p = 0,052). Multivariable analizde TNM evresi EFS'nin bağımsız belirleyicisi olarak ortaya çıkmıştır (HR 0,48; p = 0,03). Nüks/progresyon NAKT-Cerrahi hastalarının %54,8'inde ve KRT hastalarının %70,0'ında görülmüştür. Sonuçlar: Rezektabl N2 KHDAK'li uygun seçilmiş hastalar için multimodal NAKT-Cerrahi yaklaşımları definitif KRT'ye kıyasla daha iyi sağkalım sonuçları sağlamıştır. Bu bulgular rezektabilite değerlendirmesinin agresif şekilde takip edilmesini ve multimodal terapötik planlamayı desteklemektedir. Çağdaş NAKT-Cerrahi ile modern KRT artı konsolidasyon immünoterapisini karşılaştıran prospektif randomize çalışmalara ihtiyaç duyulmaktadır.

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Cite This Article

Bayram, D., Karabuga, B., Hafızoğlu, E., Köksal, Ö. F., Dogan, M., Algın, E., Uncu, D., Bal, Ö. (2026). Neoadjuvant chemotherapy with surgery versus concurrent chemoradiation in N2 non-small cell lung cancer: a retrospective comparative analysis of treatment outcomes. Turkish Journal of Clinics and Laboratory, Sayı: 1. https://doi.org/10.18663/tjcl.1837114

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